MEDICARE: AMY REGAN

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	164W00000X	Licensed Practical Nurse	P50882	IA

General Provider Information

NPI Number	:	1457213068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY REGAN

Provider Business Mailing Address
First Line	:	1216 WOODSIDE LN
Second Line	:
City	:	WAUKON
State	:	IA
Zip	:	52172-7650
Country	:	US
Telephone Number	:	563-387-5840
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 WOODSIDE LN
Second Line	:
City	:	WAUKON
State	:	IA
Zip	:	52172-7650
Country	:	US
Telephone Number	:	563-387-5840
Fax Number	:

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

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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Directions to “ AMY REGAN ” Practice Location

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