Provider Demographics
NPI:1730565219
Name:FLANAGAN, CHRISTIE (PA)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S PERRY ST
Mailing Address - Street 2:JOHNSTOWN HEALTH CENTER
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-3213
Mailing Address - Country:US
Mailing Address - Phone:518-762-3161
Mailing Address - Fax:518-762-4902
Practice Address - Street 1:700 S PERRY ST
Practice Address - Street 2:JOHNSTOWN HEALTH CENTER
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-3213
Practice Address - Country:US
Practice Address - Phone:518-762-3161
Practice Address - Fax:518-762-4902
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018876363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant