Healthcare Provider Details

I. General information

NPI: 1124407176
Provider Name (Legal Business Name): JESSICA MARSHALL REGAN RDN, LDN, FMN, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 VIP DR STE 310
WEXFORD PA
15090-6936
US

IV. Provider business mailing address

70 ALLEN DR
PITTSBURGH PA
15214-1402
US

V. Phone/Fax

Practice location:
  • Phone: 724-934-3905
  • Fax:
Mailing address:
  • Phone: 724-984-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN005561
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: