Provider Demographics
NPI:1073918876
Name:ROBERTO, REGINA
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:ROBERTO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:ROBERTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:100 INSTITUTE RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2247
Mailing Address - Country:US
Mailing Address - Phone:508-831-5520
Mailing Address - Fax:508-831-5953
Practice Address - Street 1:100 INSTITUTE RD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2247
Practice Address - Country:US
Practice Address - Phone:508-831-5520
Practice Address - Fax:508-831-5953
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154005363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health