Provider Demographics
NPI:1073881066
Name:REGINA, LAUREN EVAN (RD)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:EVAN
Last Name:REGINA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2714 KINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-1930
Mailing Address - Country:US
Mailing Address - Phone:610-252-1914
Mailing Address - Fax:
Practice Address - Street 1:225 ERDMAN ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-2043
Practice Address - Country:US
Practice Address - Phone:610-588-2225
Practice Address - Fax:610-588-2292
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004147133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered