Provider Demographics
NPI:1861512162
Name:WITTENBERG, REGINA (RNFA)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:
Last Name:WITTENBERG
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 GRANDE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1188
Mailing Address - Country:US
Mailing Address - Phone:732-240-2852
Mailing Address - Fax:
Practice Address - Street 1:271 GRANDE RIVER BLVD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-1188
Practice Address - Country:US
Practice Address - Phone:732-240-2852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO06031600163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant