Provider Demographics
NPI:1427460567
Name:REGGI, JOHNNA RAY (MS, CNM, WHNP-BC)
Entity type:Individual
Prefix:
First Name:JOHNNA
Middle Name:RAY
Last Name:REGGI
Suffix:
Gender:F
Credentials:MS, CNM, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S. WOOD ST.
Mailing Address - Street 2:M/C 808
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-996-4390
Mailing Address - Fax:
Practice Address - Street 1:1801 W. TAYLOR ST.
Practice Address - Street 2:SUITE 4C M/C 650
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-413-7500
Practice Address - Fax:312-413-3856
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041433067367A00000X
IL309008640367A00000X
IL209015606367A00000X
IL209012988367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife