Provider Demographics
NPI:1922624006
Name:SHARPE, REGINA
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:SHARPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:WALNUTPORT
Mailing Address - State:PA
Mailing Address - Zip Code:18088-0067
Mailing Address - Country:US
Mailing Address - Phone:610-760-1932
Mailing Address - Fax:
Practice Address - Street 1:1115 MYRTLE RD
Practice Address - Street 2:
Practice Address - City:WALNUTPORT
Practice Address - State:PA
Practice Address - Zip Code:18088-9445
Practice Address - Country:US
Practice Address - Phone:610-730-9228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA26283601374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide