Healthcare Provider Details

I. General information

NPI: 1255578738
Provider Name (Legal Business Name): REGINA REAUME RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47601 GRAND RIVER AVE
NOVI MI
48374-1233
US

IV. Provider business mailing address

10939 BYRON RD
HOWELL MI
48855-8345
US

V. Phone/Fax

Practice location:
  • Phone: 248-465-3180
  • Fax:
Mailing address:
  • Phone: 517-548-7994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number4704201505
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: