Provider Demographics
NPI:1558185371
Name:REGAN, MICHELLE CYNTHIA
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CYNTHIA
Last Name:REGAN
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 1:145 KIMBALL RD
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-5313
Mailing Address - Country:US
Mailing Address - Phone:978-852-9704
Mailing Address - Fax:
Practice Address - Street 1:145 KIMBALL RD
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-5313
Practice Address - Country:US
Practice Address - Phone:978-852-9704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2290664163W00000X
MAL-311885163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse