Individual
REGINA MARIE FORMENTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
6242 E ARBOR AVE STE 111, MESA, AZ 85206-1309
(602) 755-0800
(602) 560-2721
Mailing address
11500 E COCHISE DR UNIT 2104, SCOTTSDALE, AZ 85259-4931
(734) 309-9908
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
254655
AZ
Other
Enumeration date
02/25/2021
Last updated
08/27/2024
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