Individual
REGINA D PRINCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1808 W MAIN ST, RUSSELLVILLE, AR 72801-2724
(479) 968-2841
Mailing address
PO BOX 1351, RUSSELLVILLE, AR 72811-1351
(800) 235-1415
(913) 234-1108
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C02671
AR
367500000X
Certified Registered Nurse Anesthetist
CTP000048
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165275001
—
AR
01
—
5A423
BCBS
AR
01
—
771053701
AR BREASTCARE
AR
01
—
P00603893
RR MEDICARE FOR GROUP CC5970
AR
Enumeration date
06/11/2007
Last updated
02/24/2014
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