Regina Renee Johnson, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704236041 Issued in MI

Practice address

4301 Orchard Lake Rd Ste 180
West Bloomfield, MI 48323-1684

Phone

(313) 492-5807

NPI assigned

Jun 27, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Regina Renee Waller Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508976000000",
    "number": "1356781041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 ORCHARD LAKE RD STE 180",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483231684",
            "telephone_number": "313-492-5807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 ORCHARD LAKE RD STE 180",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483231684",
            "telephone_number": "313-492-5807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "REGINA",
        "middle_name": "RENEE",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-06-27",
        "last_updated": "2017-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704236041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REGINA",
            "last_name": "WALLER",
            "middle_name": "RENEE",
            "prefix": "MS.",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Chelsea Suzanne Johnson, LLMSW
• Christina Johnson, RRT
• Leah Jean Johnson, MSW, LMSW-C
• Michael Brian Johnson, M.A. LPC
• Michele Johnson, LMSW
• Richard Brian Johnson, D.C.
• Shadesha Johnson
• Yevgeniya Johnson
• Yvonne Louise Johnson, PA-C
• Paul M. Johnston, M.D.

• Nurse Practitioner in West Bloomfield, MI
• Providers in West Bloomfield, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.