Provider Demographics
NPI:1306198833
Name:CROSLEY-CORCORAN, REGINA NICOLE (CD(DONA), CCCE)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:NICOLE
Last Name:CROSLEY-CORCORAN
Suffix:
Gender:F
Credentials:CD(DONA), CCCE
Other - Prefix:MRS
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:CROSLEY-CORCORAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CD(DONA), CCCE
Mailing Address - Street 1:330 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3116
Mailing Address - Country:US
Mailing Address - Phone:773-329-3399
Mailing Address - Fax:
Practice Address - Street 1:330 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3116
Practice Address - Country:US
Practice Address - Phone:773-329-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula