Provider Demographics
NPI:1124407176
Name:REGAN, JESSICA MARSHALL (RDN, LDN, FMN, CLT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARSHALL
Last Name:REGAN
Suffix:
Gender:F
Credentials:RDN, LDN, FMN, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 ALLEN DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15214-1402
Mailing Address - Country:US
Mailing Address - Phone:724-984-3911
Mailing Address - Fax:
Practice Address - Street 1:117 VIP DR STE 310
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-6936
Practice Address - Country:US
Practice Address - Phone:724-934-3905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005561133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered