Provider Demographics
NPI:1992235329
Name:REGAN, VICTORIA LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNN
Last Name:REGAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1248 LEVEL RD
Mailing Address - Street 2:
Mailing Address - City:LILLY
Mailing Address - State:PA
Mailing Address - Zip Code:15938-6027
Mailing Address - Country:US
Mailing Address - Phone:814-381-6735
Mailing Address - Fax:
Practice Address - Street 1:4186 CORTLAND DR
Practice Address - Street 2:
Practice Address - City:NEW PARIS
Practice Address - State:PA
Practice Address - Zip Code:15554-7706
Practice Address - Country:US
Practice Address - Phone:814-839-4108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059066363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant