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General NPI Number Information
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NPI Number | 1205615648
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Entity Type | Individual
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Provider Name | REGINA RENA HARPER
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Gender | Female
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 13560 E MCNICHOLS STE 142D
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City | DETROIT
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State | MI
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Zip | 48205
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Country | US
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Telephone | 313-729-4547
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Fax | 313-668-6148
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Provider Business Mailing Address
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Address Line | 46504 VILLAGGIO CT
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City | UTICA
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State | MI
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Zip | 48315-4165
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Country | US
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Telephone | 586-243-5776
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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