Healthcare Provider Details

I. General information

NPI: 1831212588
Provider Name (Legal Business Name): NELLIE L FLANAGAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E 3RD ST
CHATTANOOGA TN
37403-2102
US

IV. Provider business mailing address

436 STONERIDGE DR
HIXSON TN
37343-2894
US

V. Phone/Fax

Practice location:
  • Phone: 423-209-8162
  • Fax:
Mailing address:
  • Phone: 423-875-4653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0000071326
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: