Provider Demographics
NPI:1346440013
Name:MUIR, REGINA G (CPNP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:G
Last Name:MUIR
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:SUITE 104
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-638-2900
Mailing Address - Fax:631-878-8083
Practice Address - Street 1:492 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:EAST MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11940-1347
Practice Address - Country:US
Practice Address - Phone:631-638-2900
Practice Address - Fax:631-878-8083
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF381158-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics