Provider Demographics
NPI:1073563730
Name:REGEHR, MICHELLE Y (NP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:Y
Last Name:REGEHR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:411 HAMILTON BLVD
Mailing Address - Street 2:SUITE 1824
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-1144
Mailing Address - Country:US
Mailing Address - Phone:309-494-9320
Mailing Address - Fax:309-494-9321
Practice Address - Street 1:5200 RELIABLE PARKWAY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60686-0001
Practice Address - Country:US
Practice Address - Phone:309-671-8748
Practice Address - Fax:309-671-8740
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK12671Medicare PIN