Provider Demographics
NPI:1972853885
Name:REGONINI, RACHEL MARIE (RN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:REGONINI
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 1:250 ALLSTON ST
Mailing Address - Street 2:APARTMENT A
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7660
Mailing Address - Country:US
Mailing Address - Phone:602-684-2882
Mailing Address - Fax:
Practice Address - Street 1:105 VICTORY ROAD
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122
Practice Address - Country:US
Practice Address - Phone:617-371-3010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2278582163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse