Provider Demographics
NPI:1659508901
Name:REGULA, DONNA MAE (MPA,RD,)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MAE
Last Name:REGULA
Suffix:
Gender:F
Credentials:MPA,RD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 ACADEMY FARMS DR
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-5023
Mailing Address - Country:US
Mailing Address - Phone:804-598-1332
Mailing Address - Fax:804-598-1109
Practice Address - Street 1:3160 ACADEMY FARMS DR
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-5023
Practice Address - Country:US
Practice Address - Phone:804-598-1332
Practice Address - Fax:804-598-1109
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-14
Last Update Date:2009-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL714161133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered