Provider Demographics
NPI:1871644039
Name:MILLER, REGINA MARIE (CRNP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:MARIE
Other - Last Name:SEABOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8752 ASPEN GROVE CT
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-2229
Mailing Address - Country:US
Mailing Address - Phone:443-871-1878
Mailing Address - Fax:410-379-3591
Practice Address - Street 1:6095 MARSHALEE DR
Practice Address - Street 2:EVERCARE 1ST FLOOR
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6053
Practice Address - Country:US
Practice Address - Phone:410-379-3400
Practice Address - Fax:410-379-3591
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR131611363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology