Provider Demographics
NPI:1619419405
Name:FLAVIN, ERIN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:FLAVIN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 S RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3629
Mailing Address - Country:US
Mailing Address - Phone:406-203-9948
Mailing Address - Fax:406-203-9949
Practice Address - Street 1:1511 S RUSSELL ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801
Practice Address - Country:US
Practice Address - Phone:406-203-9948
Practice Address - Fax:406-203-9949
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-105076363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health