| Doctor Name: | MICHELLE LEIGH REGAN |
| NPI Number: | 1003841206 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PPCNP-BC |
| License Number: | 4704200949 |
| Business Practice Address: | 95 E 120th St Grant, MI - 493278623 |
| Business Phone Number: | 2318341350 |
| Business Fax Number: | 2318341355 |
| Mailing Address: | 1615 Michigan Ave, BALDWIN |
| State: | MI |
| Postal Code: | 493047984 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/12/2006 |
| NPI Last Update Date: | 08/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 4704200949 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |