Provider Demographics
NPI:1194195487
Name:LEEREK, REGINA MARTHA STELTER (MSN, RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:MARTHA STELTER
Last Name:LEEREK
Suffix:
Gender:F
Credentials:MSN, RN, FNP-C
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:MARTHA
Other - Last Name:STELTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, RN, FNP-C
Mailing Address - Street 1:309 PARK ST
Mailing Address - Street 2:
Mailing Address - City:POYNETTE
Mailing Address - State:WI
Mailing Address - Zip Code:53955-8965
Mailing Address - Country:US
Mailing Address - Phone:608-697-1106
Mailing Address - Fax:
Practice Address - Street 1:600 EAST ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514
Practice Address - Country:US
Practice Address - Phone:574-294-2621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005790A363LF0000X
WI6305 - 33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily