Provider Demographics
NPI:1588797906
Name:FORAN, REGINA H (CNM)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:H
Last Name:FORAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6207 WINNEPEG DR
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3849
Mailing Address - Country:US
Mailing Address - Phone:703-239-0264
Mailing Address - Fax:
Practice Address - Street 1:7500 IRON BAR LN
Practice Address - Street 2:SUITE 219
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3603
Practice Address - Country:US
Practice Address - Phone:703-753-0963
Practice Address - Fax:703-753-2367
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165565367A00000X
DCRN1006395367A00000X
VA0129000080176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife