Provider Demographics
NPI:1891354502
Name:REGALADO, MARCIA A (RN)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:A
Last Name:REGALADO
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 1:11208 KENNEBEC AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1008
Mailing Address - Country:US
Mailing Address - Phone:586-416-0845
Mailing Address - Fax:
Practice Address - Street 1:11208 KENNEBEC AVE
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1008
Practice Address - Country:US
Practice Address - Phone:586-416-0845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704268978163WH1000X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WH1000XNursing Service ProvidersRegistered NurseHospice