Provider Demographics
NPI:1760174411
Name:ANDERSON, REGINA MARIE
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10366 COBURG LANDS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63137-2332
Mailing Address - Country:US
Mailing Address - Phone:314-704-1015
Mailing Address - Fax:
Practice Address - Street 1:10366 COBURG LANDS DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63137-2332
Practice Address - Country:US
Practice Address - Phone:314-704-1015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health