Provider Demographics
NPI:1407160161
Name:HUMPHREYS, REGINA E (LPN)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:E
Last Name:HUMPHREYS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:E
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 OVERBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15210-4425
Mailing Address - Country:US
Mailing Address - Phone:412-337-2151
Mailing Address - Fax:
Practice Address - Street 1:2250 HICKORY RD
Practice Address - Street 2:SUITE 240
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1047
Practice Address - Country:US
Practice Address - Phone:180-087-7944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN104063L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse