Active NPI
Michelle Leigh Regan, PPCNP-BC
- Pediatric Nurse Practitioner
- Grant, MI
National Provider Identifier
1003841206
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 4704200949
- Practice address
- 95 E 120TH St
Grant, MI 49327-8623 - Phone
- (231) 834-1350
- Fax
- (231) 834-1355
- NPI assigned
- Jul 12, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 4704200949 | MI | Primary |
Addresses
Primary practice location
95 E 120TH St
Grant, MI 49327-8623
Mailing address
1615 Michigan Ave
Baldwin, MI 49304-7984
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4749993 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Pediatric Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704200949 | MI | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439337600000",
"number": "1003841206",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1615 MICHIGAN AVE",
"city": "BALDWIN",
"state": "MI",
"postal_code": "493047984"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "95 E 120TH ST",
"city": "GRANT",
"state": "MI",
"postal_code": "493278623",
"telephone_number": "231-834-1350",
"fax_number": "231-834-1355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REGAN",
"first_name": "MICHELLE",
"middle_name": "LEIGH",
"credential": "PPCNP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-12",
"last_updated": "2015-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "MI",
"license": "4704200949",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4749993",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grant, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.