Provider Demographics
NPI:1558978791
Name:MILLER, REGINA C (APRN)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:C
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:C
Other - Last Name:CARIDEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:264 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2551
Mailing Address - Country:US
Mailing Address - Phone:603-224-3368
Mailing Address - Fax:603-228-7268
Practice Address - Street 1:264 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2551
Practice Address - Country:US
Practice Address - Phone:603-224-3368
Practice Address - Fax:603-228-7268
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAG07200043363L00000X
NH08362023363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner