Provider Demographics
NPI:1720582885
Name:KERANEN, REGINA ANN
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:ANN
Last Name:KERANEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:REGINA
Other - Middle Name:ANN
Other - Last Name:ATWATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MICHIGAN HEALTH SYSTEM
Mailing Address - Street 2:1500 E. MEDICAL CENTER DRIVE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109
Mailing Address - Country:US
Mailing Address - Phone:734-936-7070
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF MICHIGAN HEALTH SYSTEM
Practice Address - Street 2:1500 E. MEDICAL CENTER DRIVE
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109
Practice Address - Country:US
Practice Address - Phone:734-936-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011519225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist