Provider Demographics
NPI:1649492497
Name:FLYNN, MICHELE NORAH (RD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:NORAH
Last Name:FLYNN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:NORAH
Other - Middle Name:
Other - Last Name:FLYNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:515 E FAIRMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-1707
Mailing Address - Country:US
Mailing Address - Phone:818-847-3447
Mailing Address - Fax:818-847-4034
Practice Address - Street 1:501 S BUENA VISTA ST
Practice Address - Street 2:RADIATION ONCOLOGY
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4809
Practice Address - Country:US
Practice Address - Phone:818-847-3447
Practice Address - Fax:818-847-4034
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0587378133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered