Healthcare Provider Details

I. General information

NPI: 1891510137
Provider Name (Legal Business Name): REGINA OKINE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6050 POPES CREEK PL
HAYMARKET VA
20169-5422
US

IV. Provider business mailing address

6050 POPES CREEK PL
HAYMARKET VA
20169-5422
US

V. Phone/Fax

Practice location:
  • Phone: 703-565-3903
  • Fax:
Mailing address:
  • Phone: 703-565-3903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number11001421
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: