Provider Demographics
NPI:1093736704
Name:REGAN, RUTH ELAINE (CNM)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ELAINE
Last Name:REGAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:
Other - Last Name:REGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1900 HOT SPRINGS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-3481
Mailing Address - Country:US
Mailing Address - Phone:505-401-4791
Mailing Address - Fax:
Practice Address - Street 1:1900 HOT SPRINGS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-3481
Practice Address - Country:US
Practice Address - Phone:505-401-4791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM261367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM92213Medicaid