Basic Information
| Provider Information | |||||||||
| NPI: | 1679845648 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLANAGAN | ||||||||
| FirstName: | MAUREEN | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 ATLANTIC ST | ||||||||
| Address2: | |||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069026805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033275111 | ||||||||
| FaxNumber: | 2033272991 | ||||||||
| Practice Location | |||||||||
| Address1: | 805 ATLANTIC ST | ||||||||
| Address2: | |||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069026805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033275111 | ||||||||
| FaxNumber: | 2033272991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2012 | ||||||||
| LastUpdateDate: | 01/13/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 004901 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 004234788 | 05 | CT | MEDICAID |