Provider Demographics
NPI:1427047687
Name:FLANAGAN, MICHELE M (NP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:M
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:M
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 872104
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85287-2104
Mailing Address - Country:US
Mailing Address - Phone:480-965-3349
Mailing Address - Fax:480-965-8914
Practice Address - Street 1:451 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5391
Practice Address - Country:US
Practice Address - Phone:480-965-3349
Practice Address - Fax:480-965-8914
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ906345Medicaid
TX290713101Medicaid
P05714Medicare UPIN
AZ906345Medicaid
TX290713101Medicaid