Provider Demographics
NPI:1639157597
Name:ROSS, REGINA HOPE (C R N A)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:HOPE
Last Name:ROSS
Suffix:
Gender:F
Credentials:C R N A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14536 TEALBY DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-1581
Mailing Address - Country:US
Mailing Address - Phone:804-833-1415
Mailing Address - Fax:804-818-3461
Practice Address - Street 1:14536 TEALBY DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-1581
Practice Address - Country:US
Practice Address - Phone:336-406-8352
Practice Address - Fax:804-818-3461
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001212850367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1639157597Medicare PIN