Healthcare Provider Details

I. General information

NPI: 1073795712
Provider Name (Legal Business Name): REGINA SMILING LOCKLEAR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 SMILING RD
MAXTON NC
28364-8851
US

IV. Provider business mailing address

676 SMILING RD
MAXTON NC
28364-8851
US

V. Phone/Fax

Practice location:
  • Phone: 910-844-3254
  • Fax:
Mailing address:
  • Phone: 910-844-3254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number148542
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: