Provider Demographics
NPI:1073795712
Name:LOCKLEAR, REGINA SMILING (RN)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:SMILING
Last Name:LOCKLEAR
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 1:676 SMILING RD
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-8851
Mailing Address - Country:US
Mailing Address - Phone:910-844-3254
Mailing Address - Fax:
Practice Address - Street 1:676 SMILING RD
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-8851
Practice Address - Country:US
Practice Address - Phone:910-844-3254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH148542372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion