Provider Demographics
NPI:1306451240
Name:EVANS, REGINA ANN
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:ANN
Last Name:EVANS
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 1:8880 W SUNSET RD STE 320
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5007
Mailing Address - Country:US
Mailing Address - Phone:702-293-4488
Mailing Address - Fax:702-293-4487
Practice Address - Street 1:1252 WYOMING ST STE 200
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-2802
Practice Address - Country:US
Practice Address - Phone:702-293-4488
Practice Address - Fax:702-293-4487
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV827628363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily