Provider Demographics
NPI:1619274560
Name:THOMAS, REGINA MARIE (RN)
Entity Type:Individual
Prefix:MISS
First Name:REGINA
Middle Name:MARIE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 W VLIET ST APT 594
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205-2551
Mailing Address - Country:US
Mailing Address - Phone:414-477-7842
Mailing Address - Fax:
Practice Address - Street 1:817 W VLIET ST APT 594
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-2551
Practice Address - Country:US
Practice Address - Phone:414-477-7842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI189507-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse