Healthcare Provider Details

I. General information

NPI: 1508796459
Provider Name (Legal Business Name): REGINA WILSON-SHRADER RNC-MNN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 TERRACINA BLVD
REDLANDS CA
92373-4897
US

IV. Provider business mailing address

350 TERRACINA BLVD
REDLANDS CA
92373-4897
US

V. Phone/Fax

Practice location:
  • Phone: 909-645-0592
  • Fax:
Mailing address:
  • Phone: 909-645-0592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number558098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: