Provider Demographics
NPI:1093757916
Name:FLANAGAN, NICOLE LYNN (PMHNP-BC, MSN, RN,BA)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:LYNN
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:PMHNP-BC, MSN, RN,BA
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:LYNN
Other - Last Name:LAMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BA
Mailing Address - Street 1:154 WATERMAN ST
Mailing Address - Street 2:STE 15, 3RD FL
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3116
Mailing Address - Country:US
Mailing Address - Phone:401-251-0628
Mailing Address - Fax:401-340-1580
Practice Address - Street 1:154 WATERMAN ST
Practice Address - Street 2:STE 15, 3RD FL
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-3116
Practice Address - Country:US
Practice Address - Phone:401-251-0628
Practice Address - Fax:401-340-1580
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN40482163W00000X
RIAPRN00477363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1093757916OtherHARVARD PILGRIM
RI1093757916OtherUNICARE
RI1093757916OtherTUFTS
RI1093757916OtherCIGNA
RI1093757916OtherAETNA
RI1093757916OtherUBH
RI1093757916OtherBLUE CROSS BLUE SHIELD
RINF51367Medicaid