Provider Demographics
NPI:1104896075
Name:PRINDLE, REGINA MILLER (PHD, FNP)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:MILLER
Last Name:PRINDLE
Suffix:
Gender:
Credentials:PHD, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-1387
Mailing Address - Country:US
Mailing Address - Phone:208-415-0299
Mailing Address - Fax:208-625-2070
Practice Address - Street 1:3700 W SELTICE WAY
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-8921
Practice Address - Country:US
Practice Address - Phone:208-620-5255
Practice Address - Fax:844-807-3782
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ID473A363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health