Provider Demographics
NPI:1811379464
Name:REGAN, ANN MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:REGAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HACKENSACK HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-6113
Mailing Address - Country:US
Mailing Address - Phone:845-380-3549
Mailing Address - Fax:
Practice Address - Street 1:18 HACKENSACK HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-6113
Practice Address - Country:US
Practice Address - Phone:845-380-3549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315160-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse