Provider Demographics
NPI:1760634729
Name:LANZA, REGINA ANGELA (RN)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:ANGELA
Last Name:LANZA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W193S7842 OVERLOOK BAY RD # 6D
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-7813
Mailing Address - Country:US
Mailing Address - Phone:414-254-1830
Mailing Address - Fax:
Practice Address - Street 1:W193S7842 OVERLOOK BAY RD # 6D
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-7813
Practice Address - Country:US
Practice Address - Phone:414-254-1830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI141161-303140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric