Provider Demographics
NPI:1407327315
Name:HEAGEN, REGAN ELAINE
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:ELAINE
Last Name:HEAGEN
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 1:631 BRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-6940
Mailing Address - Country:US
Mailing Address - Phone:419-424-0815
Mailing Address - Fax:419-424-1405
Practice Address - Street 1:710 FOX RUN RD
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-7169
Practice Address - Country:US
Practice Address - Phone:419-424-0815
Practice Address - Fax:419-424-1405
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023093363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care