MEDICARE: REGINA L BRAY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	70786	HI
2	363LF0000X	Family Nurse Practitioner	4563-0	HI

General Provider Information

NPI Number	:	1407607377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA L BRAY NP

Provider Business Mailing Address
First Line	:	91-1001 KEAUNUI DR UNIT 201
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-6331
Country	:	US
Telephone Number	:	808-348-1989
Fax Number	:

Provider Business Practice Location Address
First Line	:	91-1001 KEAUNUI DR UNIT 201
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-6331
Country	:	US
Telephone Number	:	808-348-1989
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	05/03/2024

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