Provider Demographics
NPI:1134282601
Name:REGINELLI, BROOKE LEANNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:LEANNE
Last Name:REGINELLI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:BROOKE
Other - Middle Name:LEANNE
Other - Last Name:OSBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:47 SKYWALKER CT
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973
Mailing Address - Country:US
Mailing Address - Phone:530-588-3420
Mailing Address - Fax:
Practice Address - Street 1:107 PARMAC ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926
Practice Address - Country:US
Practice Address - Phone:530-891-2784
Practice Address - Fax:530-891-2809
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN640770163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN640770OtherLICENSE