Provider Demographics
NPI:1992313191
Name:WATERS, REGINA
Entity type:Individual
Prefix:MISS
First Name:REGINA
Middle Name:
Last Name:WATERS
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 1:5256 FIGHTING FISH WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-0621
Mailing Address - Country:US
Mailing Address - Phone:702-970-1449
Mailing Address - Fax:702-368-0318
Practice Address - Street 1:5256 FIGHTING FISH WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-0621
Practice Address - Country:US
Practice Address - Phone:702-970-1449
Practice Address - Fax:702-368-0318
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10060-PCS-03747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV10060-PCS-0OtherDEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF PUBLIC AND BEHAVORIAL HEALTH