Provider Demographics
NPI:1376894386
Name:REGNITZ, CLAIRE MARIE (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:MARIE
Last Name:REGNITZ
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 E BASELINE RD STE C2
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1528
Mailing Address - Country:US
Mailing Address - Phone:480-751-3777
Mailing Address - Fax:
Practice Address - Street 1:1840 E BASELINE RD STE C2
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1528
Practice Address - Country:US
Practice Address - Phone:480-751-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5223363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant