Provider Demographics
NPI:1063394138
Name:ANNOR, REGINA ASANTEWAA (NP)
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:ASANTEWAA
Last Name:ANNOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:REGINA
Other - Middle Name:ASANTEWAA
Other - Last Name:NIMAKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1650 N FARWELL AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2331
Mailing Address - Country:US
Mailing Address - Phone:414-277-5054
Mailing Address - Fax:
Practice Address - Street 1:1650 N FARWELL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2331
Practice Address - Country:US
Practice Address - Phone:414-277-5054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1712233363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner