Provider Demographics
NPI:1841312683
Name:FLATTERY, MAUREEN P (NP)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:P
Last Name:FLATTERY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 LAUREL TOP DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-5152
Mailing Address - Country:US
Mailing Address - Phone:804-378-4461
Mailing Address - Fax:
Practice Address - Street 1:1400 GROTON CT
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3254
Practice Address - Country:US
Practice Address - Phone:804-378-4461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165357363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner