Healthcare Provider Details

I. General information

NPI: 1578702692
Provider Name (Legal Business Name): REGAN MENSCH BROWN ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SUNNYBROOK ROAD WOMENS HEALTH CLINIC
RALEIGH NC
27620-4049
US

IV. Provider business mailing address

109 CAPE COD DR
CARY NC
27511-4371
US

V. Phone/Fax

Practice location:
  • Phone: 919-250-3920
  • Fax:
Mailing address:
  • Phone: 919-467-4409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number212695
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: