Basic Information
| Provider Information | |||||||||
| NPI: | 1922062025 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLAHAVEN | ||||||||
| FirstName: | MOLLIE | ||||||||
| MiddleName: | MAHANNA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | NP, RN | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MAHANNA | ||||||||
| OtherFirstName: | MOLLIE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 78 ATLANTIC PL | ||||||||
| Address2: | |||||||||
| City: | SOUTH PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041062316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076616654 | ||||||||
| FaxNumber: | 2078427773 | ||||||||
| Practice Location | |||||||||
| Address1: | 46 BARRA RD | ||||||||
| Address2: | |||||||||
| City: | BIDDEFORD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040059459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072823349 | ||||||||
| FaxNumber: | 2072948898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 09/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN48244 | ME | N | Nursing Service Providers | Registered Nurse | 363LP0808X | CNP81173 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.