Provider Demographics
NPI:1851766364
Name:FLANAGAN, RAENA K (NP-C)
Entity Type:Individual
Prefix:
First Name:RAENA
Middle Name:K
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 OLD SHORT HILLS RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5672
Mailing Address - Country:US
Mailing Address - Phone:973-818-3664
Mailing Address - Fax:
Practice Address - Street 1:34 WOODLAND RD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-5212
Practice Address - Country:US
Practice Address - Phone:973-818-3664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00602100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health