Provider Demographics
NPI:1750828778
Name:REGIS COLLEGE
Entity Type:Organization
Organization Name:REGIS COLLEGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKERING BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-395-0057
Mailing Address - Street 1:50 DEXTER ST
Mailing Address - Street 2:1
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-6668
Mailing Address - Country:US
Mailing Address - Phone:781-395-0057
Mailing Address - Fax:
Practice Address - Street 1:50 DEXTER ST
Practice Address - Street 2:1
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-6668
Practice Address - Country:US
Practice Address - Phone:781-395-0057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-28
Last Update Date:2017-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center