Provider Demographics
NPI:1679845648
Name:FLANAGAN, MAUREEN (APRN)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
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 1:805 ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-6805
Mailing Address - Country:US
Mailing Address - Phone:203-327-5111
Mailing Address - Fax:203-327-2991
Practice Address - Street 1:805 ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-6805
Practice Address - Country:US
Practice Address - Phone:203-327-5111
Practice Address - Fax:203-327-2991
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004901363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004234788Medicaid
CTC00383Medicare Oscar/Certification