Provider Demographics
NPI:1679932636
Name:CALLAGHAN, REGINA (REGINA CALLAGHAN)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:CALLAGHAN
Suffix:
Gender:F
Credentials:REGINA CALLAGHAN
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:CALLAGHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGINA CALLAGHAN
Mailing Address - Street 1:1441 COTTONTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-4956
Mailing Address - Country:US
Mailing Address - Phone:434-609-4744
Mailing Address - Fax:
Practice Address - Street 1:1421 5TH ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-4204
Practice Address - Country:US
Practice Address - Phone:434-609-4744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
VA0024173420363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No174400000XOther Service ProvidersSpecialist