Basic Information
Provider Information | |||||||||
NPI: | 1134282601 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | REGINELLI | ||||||||
FirstName: | BROOKE | ||||||||
MiddleName: | LEANNE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | RN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | OSBURN | ||||||||
OtherFirstName: | BROOKE | ||||||||
OtherMiddleName: | LEANNE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RN | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 47 SKYWALKER CT | ||||||||
Address2: |   | ||||||||
City: | CHICO | ||||||||
State: | CA | ||||||||
PostalCode: | 95973 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5305883420 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 107 PARMAC ROAD | ||||||||
Address2: | SUITE 2 | ||||||||
City: | CHICO | ||||||||
State: | CA | ||||||||
PostalCode: | 95926 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5308912784 | ||||||||
FaxNumber: | 5308912809 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/18/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN640770 | CA | Y |   | Nursing Service Providers | Registered Nurse |   |
ID Information
ID | Type | State | Issuer | Description | RN640770 | 01 | CA | LICENSE | OTHER |