Provider Demographics
NPI:1508562687
Name:REGACHO, ERIKA MARIE (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ERIKA MARIE
Middle Name:
Last Name:REGACHO
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 W 14TH PL UNIT 318
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2843
Mailing Address - Country:US
Mailing Address - Phone:630-550-9454
Mailing Address - Fax:
Practice Address - Street 1:3023 N CLARK ST STE 593
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5200
Practice Address - Country:US
Practice Address - Phone:630-550-9454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209026734363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health