Healthcare Provider Details

I. General information

NPI: 1770831349
Provider Name (Legal Business Name): ELIZABETH ANNE WIGHT-REGNA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 07/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WHITE SPRUCE BLVD SUITE 220
ROCHESTER NY
14623-1605
US

IV. Provider business mailing address

1318 BROOKEDGE DR
HAMLIN NY
14464-9360
US

V. Phone/Fax

Practice location:
  • Phone: 585-279-5100
  • Fax: 585-424-1008
Mailing address:
  • Phone: 716-498-2983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number336895
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF336895-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: