Provider Demographics
NPI:1982661930
Name:HATHAWAY, REGINA L (FNP)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:L
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2485D HEMBY LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3733
Mailing Address - Country:US
Mailing Address - Phone:252-758-5888
Mailing Address - Fax:252-758-9888
Practice Address - Street 1:2485D HEMBY LN
Practice Address - Street 2:MED CAREEAST PA
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3733
Practice Address - Country:US
Practice Address - Phone:252-758-5888
Practice Address - Fax:252-758-9888
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201135363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000999Medicaid
NCP01346Medicare UPIN
NC7000999Medicaid