Healthcare Provider Details

I. General information

NPI: 1366057838
Provider Name (Legal Business Name): REGINA NORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3744 HAYES ST NE APT 1
WASHINGTON DC
20019-1723
US

IV. Provider business mailing address

103 BLUESTONE CT
MARTINSBURG WV
25401-8099
US

V. Phone/Fax

Practice location:
  • Phone: 202-399-0374
  • Fax:
Mailing address:
  • Phone: 202-717-2236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: