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General NPI Number Information
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NPI Number | 1770831349
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Entity Type | Individual
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Provider Name | ELIZABETH ANNE WIGHT-REGNA NP
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Gender | Female
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 200 WHITE SPRUCE BLVD SUITE 220
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City | ROCHESTER
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State | NY
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Zip | 14623-1605
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Country | US
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Telephone | 585-279-5100
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Fax | 585-424-1008
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Provider Business Mailing Address
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Address Line | 1318 BROOKEDGE DR
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City | HAMLIN
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State | NY
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Zip | 14464-9360
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Country | US
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Telephone | 716-498-2983
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 336895
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F336895-1
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License Number State | NY
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