Provider Demographics
NPI:1376925347
Name:FELDKAMP, REGINA (RD,LD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:FELDKAMP
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 VIRGINIA LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244-1349
Mailing Address - Country:US
Mailing Address - Phone:513-706-2495
Mailing Address - Fax:
Practice Address - Street 1:555 VIRGINIA LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45244-1349
Practice Address - Country:US
Practice Address - Phone:513-706-2495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD3629133V00000X
KYBDNDTN00218831133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered