Basic Information
| Provider Information | |||||||||
| NPI: | 1073881066 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REGINA | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | EVAN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | R.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2714 KINGSTON RD | ||||||||
| Address2: | |||||||||
| City: | EASTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180451930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102521914 | ||||||||
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| Practice Location | |||||||||
| Address1: | 225 ERDMAN ST | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180132043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105882225 | ||||||||
| FaxNumber: | 6105882292 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2011 | ||||||||
| LastUpdateDate: | 12/06/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DN004147 | PA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.