Provider Demographics
NPI:1356349864
Name:MACY, REGINA (NP)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:MACY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:L
Other - Last Name:CHRISTIANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1329
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47402-1329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2651 E DISCOVERY PKWY
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-9059
Practice Address - Country:US
Practice Address - Phone:812-353-3719
Practice Address - Fax:812-353-3713
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004268A363LG0600X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000904255OtherANTHEM PTAN
IN201144540Medicaid
TNQ42504Medicare UPIN
TN5159472OtherCIGNA
TN3640203Medicare PIN
IN715320004Medicare PIN
IN705320004Medicare PIN
TN4104701OtherBCBST
IN201144540Medicaid
TN168150OtherUNISON
TN3640203Medicaid