Healthcare Provider Details

I. General information

NPI: 1609724236
Provider Name (Legal Business Name): REGINE B STILLWELL AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14204 SUNBURST STREET
LOS ANGELES CA
91402
US

IV. Provider business mailing address

13651 WILLARD ST
PANORAMA CA
91402
US

V. Phone/Fax

Practice location:
  • Phone: 504-220-6617
  • Fax:
Mailing address:
  • Phone: 504-220-6617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG01260061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: