Provider Demographics
NPI:1164264255
Name:ANDERSEN, REGINA
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22743 W PEET RD
Mailing Address - Street 2:
Mailing Address - City:BANNISTER
Mailing Address - State:MI
Mailing Address - Zip Code:48807-9324
Mailing Address - Country:US
Mailing Address - Phone:989-233-6579
Mailing Address - Fax:
Practice Address - Street 1:8757 MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:BANNISTER
Practice Address - State:MI
Practice Address - Zip Code:48807-9338
Practice Address - Country:US
Practice Address - Phone:989-233-6579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider