Provider Demographics
NPI:1407607377
Name:BRAY, REGINA L (NP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:L
Last Name:BRAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1001 KEAUNUI DR UNIT 201
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6331
Mailing Address - Country:US
Mailing Address - Phone:808-348-1989
Mailing Address - Fax:
Practice Address - Street 1:91-1001 KEAUNUI DR UNIT 201
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-6331
Practice Address - Country:US
Practice Address - Phone:808-348-1989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI70786163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse