Provider Demographics
NPI:1215950449
Name:BREGIN, MARIANN (NP)
Entity type:Individual
Prefix:
First Name:MARIANN
Middle Name:
Last Name:BREGIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 RODEO RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4830
Mailing Address - Country:US
Mailing Address - Phone:505-471-8994
Mailing Address - Fax:505-473-1274
Practice Address - Street 1:4001 RODEO RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4830
Practice Address - Country:US
Practice Address - Phone:505-471-8994
Practice Address - Fax:505-473-1274
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR36389363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM93038356Medicaid
202015530OtherPRESBYTERIAN HEALTH PLANS
10000287OtherLOVELACE
2765720OtherUHC
NMNM026853OtherBCBS NM
QMY00000337OtherMOLINA
P96265Medicare UPIN
10000287OtherLOVELACE