Provider Demographics
NPI:1063044220
Name:FORD, REGINA ANJANETTE
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:ANJANETTE
Last Name:FORD
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 1:1230 ASHBY ST
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-4007
Mailing Address - Country:US
Mailing Address - Phone:540-885-0749
Mailing Address - Fax:
Practice Address - Street 1:1230 ASHBY ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-4007
Practice Address - Country:US
Practice Address - Phone:540-885-0749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVSS-6886347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle