Provider Demographics
NPI:1376192401
Name:FREEMAN, REGINA KAY (MSN, RN, ACNS-BC)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:KAY
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MSN, RN, ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9150 NORMANDY LN
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9284
Mailing Address - Country:US
Mailing Address - Phone:734-883-7776
Mailing Address - Fax:
Practice Address - Street 1:4726 CARDIOVASCULAR CENTER
Practice Address - Street 2:1500 E MEDICAL CENTER DR
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109
Practice Address - Country:US
Practice Address - Phone:734-883-7776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704216975364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult HealthGroup - Single Specialty