Provider Demographics
NPI:1144998360
Name:REAGAN, PAIGE (FNTP, RWP)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:REAGAN
Suffix:
Gender:F
Credentials:FNTP, RWP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 BENEDICT ST
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-3910
Mailing Address - Country:US
Mailing Address - Phone:908-839-2761
Mailing Address - Fax:
Practice Address - Street 1:1209 BENEDICT ST
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-3910
Practice Address - Country:US
Practice Address - Phone:908-839-2761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist