Provider Demographics
NPI:1427372770
Name:O'REGAN, JANATHEA MARIE (PA)
Entity type:Individual
Prefix:
First Name:JANATHEA
Middle Name:MARIE
Last Name:O'REGAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 WAKE FOREST RD.
Mailing Address - Street 2:SUITE 500
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-2752
Mailing Address - Country:US
Mailing Address - Phone:919-862-5075
Mailing Address - Fax:919-862-2682
Practice Address - Street 1:3480 WAKE FOREST RD STE 500
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7376
Practice Address - Country:US
Practice Address - Phone:919-862-5075
Practice Address - Fax:919-862-5076
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02220363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant