Provider Demographics
NPI:1083927958
Name:FLANAGAN, DONTE A (CRNA)
Entity type:Individual
Prefix:
First Name:DONTE
Middle Name:A
Last Name:FLANAGAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2636 S LOOP W
Mailing Address - Street 2:STE 560
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2953
Mailing Address - Country:US
Mailing Address - Phone:409-753-5669
Mailing Address - Fax:866-810-8005
Practice Address - Street 1:310 E. 14TH STREET
Practice Address - Street 2:NY EYE & EAR INFIRMORY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-479-4000
Practice Address - Fax:770-751-2627
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN184689367500000X
NY689952367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN184689OtherGA CRNA LICENSE