Provider Demographics
NPI:1437456340
Name:REGAN, FLORENE AVIS (RN)
Entity type:Individual
Prefix:MS
First Name:FLORENE
Middle Name:AVIS
Last Name:REGAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 CRICKET LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5603
Mailing Address - Country:US
Mailing Address - Phone:608-824-9975
Mailing Address - Fax:
Practice Address - Street 1:757 CRICKET LN
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-5603
Practice Address - Country:US
Practice Address - Phone:608-824-9975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-12
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46473-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse