Individual
REGINA MACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2651 E DISCOVERY PKWY, BLOOMINGTON, IN 47408-9059
(812) 353-3719
(812) 353-3713
Mailing address
PO BOX 1329, BLOOMINGTON, IN 47402-1329
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
71004268A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000904255
ANTHEM PTAN
IN
05
—
201144540
—
IN
Enumeration date
07/08/2005
Last updated
10/25/2024
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