Provider Demographics
NPI:1003497231
Name:WILSON, REGINA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 HUFF AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5382
Mailing Address - Country:US
Mailing Address - Phone:724-552-4975
Mailing Address - Fax:724-552-4979
Practice Address - Street 1:211 HUFF AVE STE 5
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-5382
Practice Address - Country:US
Practice Address - Phone:724-552-4975
Practice Address - Fax:724-552-4979
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN674157163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse