Healthcare Provider Details

I. General information

NPI: 1083122386
Provider Name (Legal Business Name): REGINA RADOGNA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2018
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 POOLE RD STE 120
RALEIGH NC
27610-2918
US

IV. Provider business mailing address

PO BOX 746724
ATLANTA GA
30374-6724
US

V. Phone/Fax

Practice location:
  • Phone: 919-902-7366
  • Fax:
Mailing address:
  • Phone: 773-352-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP018518
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5022431
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: