Provider Demographics
NPI:1932761293
Name:TAYLOR-THOMPSON, REGILANDA A
Entity Type:Individual
Prefix:
First Name:REGILANDA
Middle Name:A
Last Name:TAYLOR-THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LUVLUV
Other - Middle Name:
Other - Last Name:THE BARBER BEAST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5829 N 60TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-1140
Mailing Address - Country:US
Mailing Address - Phone:402-590-9654
Mailing Address - Fax:
Practice Address - Street 1:5829 N 60TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-1140
Practice Address - Country:US
Practice Address - Phone:402-590-9654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-07
Last Update Date:2019-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management