Provider Demographics
NPI:1790538742
Name:ETIM, REGINA MAURICE (SPECIMEN COLLECTOR)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:MAURICE
Last Name:ETIM
Suffix:
Gender:F
Credentials:SPECIMEN COLLECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 W 84TH DR APT G181
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-8424
Mailing Address - Country:US
Mailing Address - Phone:779-236-7071
Mailing Address - Fax:
Practice Address - Street 1:8300 BROADWAY STE A1
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6285
Practice Address - Country:US
Practice Address - Phone:779-236-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician