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NPI Code Detail

MEDICARE: REGINA LEE ENDICOTT FNP-BC

MEDICARE: REGINA LEE ENDICOTT FNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner71002206AIN

General Provider Information

NPI Number : 1639249188
Entity Type Code : Individual
Provider Name (Legal Business Name) : REGINA LEE ENDICOTT FNP-BC
Provider Business Mailing Address
First Line : 9805 GEIST CROSSING DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46256-4819
Country : US
Telephone Number : 317-577-1353
Fax Number :
Provider Business Practice Location Address
First Line : 9805 GEIST CROSSING DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46256-4819
Country : US
Telephone Number : 317-577-1353
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2006
Last Update Date : 10/10/2021

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