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General NPI Number Information
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NPI Number | 1891354502
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Entity Type | Individual
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Provider Name | MARCIA A REGALADO RN
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Gender | Female
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Dates
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Enumeration Date | 06/07/2019
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Last Update Date | 06/07/2019
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Provider Practice Location Address
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Address Line | 11208 KENNEBEC AVE
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City | ALLEN PARK
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State | MI
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Zip | 48101-1008
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Country | US
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Telephone | 586-416-0845
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Fax |
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Provider Business Mailing Address
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Address Line | 11208 KENNEBEC AVE
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City | ALLEN PARK
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State | MI
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Zip | 48101-1008
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Country | US
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Telephone | 586-416-0845
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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 | 163WH1000X
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Taxonomy Name | Hospice Registered Nurse
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License Number | 4704268978
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | 4704268978
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License Number State | MI
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