Individual
BREANNA REGGUINTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
621 W JACKSON ST, MORTON, IL 61550-1535
(309) 263-4343
Mailing address
621 W JACKSON ST, MORTON, IL 61550-1535
(309) 263-4343
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209016598
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209016598
LICENSE
IL
Enumeration date
09/20/2017
Last updated
07/21/2022
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