Healthcare Provider Details

I. General information

NPI: 1184596165
Provider Name (Legal Business Name): REGENIA PUTMAN LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 K ST
FAIRBURY NE
68352-2199
US

IV. Provider business mailing address

648 W COURT ST APT 2
BEATRICE NE
68310-3608
US

V. Phone/Fax

Practice location:
  • Phone: 402-729-6104
  • Fax:
Mailing address:
  • Phone: 402-729-6104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number28347
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: