Provider Demographics
NPI:1235401639
Name:REGAN, NICHOLE N (APRN)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:N
Last Name:REGAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:N
Other - Last Name:WIENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:3901 PINE LAKE RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5497
Mailing Address - Country:US
Mailing Address - Phone:402-421-2100
Mailing Address - Fax:402-421-2104
Practice Address - Street 1:3901 PINE LAKE RD
Practice Address - Street 2:SUITE 211
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5497
Practice Address - Country:US
Practice Address - Phone:402-421-2100
Practice Address - Fax:402-421-2104
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111308363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA2104002Medicare PIN
NENA1691005Medicare PIN