Healthcare Provider Details

I. General information

NPI: 1093757916
Provider Name (Legal Business Name): MS. NICOLE L FLANAGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. NICOLE L LAMBERT

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 WATERMAN ST STE 15
PROVIDENCE RI
02906-3116
US

IV. Provider business mailing address

154 WATERMAN ST STE 15
PROVIDENCE RI
02906-3116
US

V. Phone/Fax

Practice location:
  • Phone: 401-251-0628
  • Fax: 401-340-1580
Mailing address:
  • Phone: 401-251-0628
  • Fax: 401-340-1580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN00477
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN40482
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: