Provider Demographics
NPI:1205186251
Name:O'BRIEN, REGINA SUE
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:SUE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 HIGHWAY 62 65 S
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-4048
Mailing Address - Country:US
Mailing Address - Phone:870-204-6191
Mailing Address - Fax:
Practice Address - Street 1:808 HIGHWAY 62 65 S
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-4048
Practice Address - Country:US
Practice Address - Phone:870-204-6191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist