Provider Demographics
NPI:1205615648
Name:HARPER, REGINA RENA
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:RENA
Last Name:HARPER
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 1:46504 VILLAGGIO CT
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4165
Mailing Address - Country:US
Mailing Address - Phone:586-243-5776
Mailing Address - Fax:
Practice Address - Street 1:13560 E MCNICHOLS STE 142D
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205
Practice Address - Country:US
Practice Address - Phone:313-729-4547
Practice Address - Fax:313-668-6148
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals