Provider Demographics
NPI:1376136226
Name:FORREN, REGINA
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:FORREN
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:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:WHITE OAK
Mailing Address - State:WV
Mailing Address - Zip Code:25989-0071
Mailing Address - Country:US
Mailing Address - Phone:304-712-6059
Mailing Address - Fax:
Practice Address - Street 1:HC 76 BOX 19B
Practice Address - Street 2:
Practice Address - City:NIMITZ
Practice Address - State:WV
Practice Address - Zip Code:25978-9706
Practice Address - Country:US
Practice Address - Phone:304-712-6059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker