Provider Demographics
NPI:1669510731
Name:FLANAGAN, MARY M (APRN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 GARLAND ST
Mailing Address - Street 2:SENIOR CARE PROGRAM
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-5066
Mailing Address - Country:US
Mailing Address - Phone:617-394-7804
Mailing Address - Fax:
Practice Address - Street 1:7 RIVERWOODS DR
Practice Address - Street 2:WELLNESS CLINIC
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-4374
Practice Address - Country:US
Practice Address - Phone:603-658-3044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA140784363L00000X
NH046049-23-05363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHNP1857Medicare ID - Type Unspecified
MANP2666Medicare ID - Type Unspecified
NHS31543Medicare UPIN