Provider Demographics
NPI:1366519977
Name:JUDGE, REGINA N (CRPNP)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:N
Last Name:JUDGE
Suffix:
Gender:F
Credentials:CRPNP
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:N
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:11201 CEDAR LAKE DR APT 3H
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-5916
Mailing Address - Country:US
Mailing Address - Phone:410-456-1887
Mailing Address - Fax:
Practice Address - Street 1:451 RUIN CREEK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2878
Practice Address - Country:US
Practice Address - Phone:252-492-9565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004232363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics