Provider Demographics
NPI:1467799692
Name:DOAK, REGINA M (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:M
Last Name:DOAK
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 HIGH ROCK AVENUE
Mailing Address - Street 2:ST. PETER'S ADDICTION RECOVERY CENTER
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866
Mailing Address - Country:US
Mailing Address - Phone:518-885-6884
Mailing Address - Fax:518-885-0077
Practice Address - Street 1:125 HIGH ROCK AVENUE
Practice Address - Street 2:ST. PETER'S ADDICTION RECOVERY CENTER
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866
Practice Address - Country:US
Practice Address - Phone:518-885-6884
Practice Address - Fax:518-885-0077
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY391035-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse