Provider Demographics
NPI:1467936856
Name:MCLANE, REGIN (RDN)
Entity Type:Individual
Prefix:
First Name:REGIN
Middle Name:
Last Name:MCLANE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:REGIN
Other - Middle Name:
Other - Last Name:GALLAGHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:2441 76TH AVE SE APT 537
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3781
Mailing Address - Country:US
Mailing Address - Phone:509-279-9854
Mailing Address - Fax:
Practice Address - Street 1:1100 NINTH AVE
Practice Address - Street 2:STOP X1-DTC
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101
Practice Address - Country:US
Practice Address - Phone:206-223-6729
Practice Address - Fax:206-583-6417
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60877972133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered