Provider Demographics
NPI:1104616481
Name:BURNS, REGINA (LPN)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:BURNS
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18831 HASSE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-2141
Mailing Address - Country:US
Mailing Address - Phone:586-625-6139
Mailing Address - Fax:
Practice Address - Street 1:18831 HASSE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-2141
Practice Address - Country:US
Practice Address - Phone:586-625-6139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703121239164W00000X
253Z00000X, 251E00000X, 311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home