Provider Demographics
NPI:1063037414
Name:REGAN, GEMMA (LPN, LCCE, IBCLC)
Entity Type:Individual
Prefix:
First Name:GEMMA
Middle Name:
Last Name:REGAN
Suffix:
Gender:F
Credentials:LPN, LCCE, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PO SECURITY BUILDING UNIT 1052
Mailing Address - Street 2:
Mailing Address - City:NOTRE DAME
Mailing Address - State:IN
Mailing Address - Zip Code:46556-4704
Mailing Address - Country:US
Mailing Address - Phone:574-316-0313
Mailing Address - Fax:
Practice Address - Street 1:52026 CLOVERLEAF DR E
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637-6028
Practice Address - Country:US
Practice Address - Phone:574-274-4236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN48393174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN