Provider Demographics
NPI:1710939418
Name:REAGEN, DORIS LYNN (CNM)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:LYNN
Last Name:REAGEN
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 1:518 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-1606
Mailing Address - Country:US
Mailing Address - Phone:805-899-9818
Mailing Address - Fax:805-963-6722
Practice Address - Street 1:518 GARDEN ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-1606
Practice Address - Country:US
Practice Address - Phone:805-899-9818
Practice Address - Fax:805-963-6722
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135812905Medicaid
TX135812905Medicaid
TXS58047Medicare UPIN
TX80236MMedicare PIN