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General NPI Number Information
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NPI Number | 1255607073
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Entity Type | Individual
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Provider Name | ELIZABETH A REGAN LCPM
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Gender | Female
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 09/18/2020
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Provider Practice Location Address
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Address Line | 103 JOLOMIC LN
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City | GEORGETOWN
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State | KY
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Zip | 40324-9381
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Country | US
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Telephone | 502-229-8463
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Fax | 502-242-0082
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Provider Business Mailing Address
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Address Line | 103 JOLOMIC LN
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City | GEORGETOWN
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State | KY
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Zip | 40324-9381
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Country | US
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Telephone | 502-229-8463
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Fax | 502-242-0082
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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 | 176B00000X
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Taxonomy Name | Midwife
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License Number | 9000014
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License Number State | KY
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