Provider Demographics
NPI:1922062025
Name:FLAHAVEN, MOLLIE MAHANNA (NP, RN)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:MAHANNA
Last Name:FLAHAVEN
Suffix:
Gender:F
Credentials:NP, RN
Other - Prefix:
Other - First Name:MOLLIE
Other - Middle Name:
Other - Last Name:MAHANNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:78 ATLANTIC PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2316
Mailing Address - Country:US
Mailing Address - Phone:207-661-6654
Mailing Address - Fax:207-842-7773
Practice Address - Street 1:46 BARRA RD
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9459
Practice Address - Country:US
Practice Address - Phone:207-282-3349
Practice Address - Fax:207-294-8898
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN48244163W00000X
MECNP81173363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400104471Medicare PIN
MEE400119176Medicare PIN