Individual
REGINA M. FIACCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
981 NW SPRUCE AVE, CORVALLIS, OR 97330-2111
(541) 758-0766
Mailing address
981 NW SPRUCE AVE, CORVALLIS, OR 97330-2111
(541) 758-0766
(541) 753-2737
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA10004938
WA
363AM0700X
Medical Physician Assistant
Primary
PA158680
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
221417
L&I
WA
01
—
8441628
DSHS
—
05
—
8441628
—
WA
05
—
PA158680
—
OR
Enumeration date
03/07/2006
Last updated
03/10/2026
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