Provider Demographics
NPI:1083876551
Name:SINGH, REGINA MARIE (FNP)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:MARIE
Last Name:SINGH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SPANOS CT
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2810
Mailing Address - Country:US
Mailing Address - Phone:209-525-3170
Mailing Address - Fax:209-525-3175
Practice Address - Street 1:1401 SPANOS CT
Practice Address - Street 2:SUITE 103
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2810
Practice Address - Country:US
Practice Address - Phone:209-525-3170
Practice Address - Fax:209-525-3175
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP17579364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP17579OtherFNP