Healthcare Provider Details

I. General information

NPI: 1629595053
Provider Name (Legal Business Name): PAUL D. REGAN APN-CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24600 W 127TH ST STE B325
PLAINFIELD IL
60585-9527
US

IV. Provider business mailing address

409 MCHUGH RD
YORKVILLE IL
60560-1217
US

V. Phone/Fax

Practice location:
  • Phone: 815-731-9100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209016381
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209016381
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: