Individual
CONSTANCE LOUISE REAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2801 W KINNICKINNIC RIVER PKWY, MILWAUKEE, WI 53215-3669
(414) 649-3370
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4780-023
WI
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100091080
—
WI
Enumeration date
06/17/2019
Last updated
07/15/2025
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