Provider Demographics
NPI:1235683491
Name:MOFFETT, REGINA
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:MOFFETT
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 1:905 OAK ST
Mailing Address - Street 2:APT 44
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-1568
Mailing Address - Country:US
Mailing Address - Phone:832-988-7127
Mailing Address - Fax:
Practice Address - Street 1:905 OAK ST
Practice Address - Street 2:APT 44
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-1568
Practice Address - Country:US
Practice Address - Phone:832-988-7127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide