Provider Demographics
NPI:1013620590
Name:REGENATIVE IV'S LLC
Entity Type:Organization
Organization Name:REGENATIVE IV'S LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/RN
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:620-755-5080
Mailing Address - Street 1:421 E 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-2412
Mailing Address - Country:US
Mailing Address - Phone:620-663-2678
Mailing Address - Fax:866-557-4375
Practice Address - Street 1:421 E 30TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-2412
Practice Address - Country:US
Practice Address - Phone:620-663-2678
Practice Address - Fax:866-557-4375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-30
Last Update Date:2023-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SH1100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHolisticGroup - Single Specialty