Provider Demographics
NPI:1871909622
Name:BLAUVELT, REGINA ANN (FNP)
Entity type:Individual
Prefix:MS
First Name:REGINA
Middle Name:ANN
Last Name:BLAUVELT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 WHITING HILL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1005
Mailing Address - Country:US
Mailing Address - Phone:207-947-6141
Mailing Address - Fax:
Practice Address - Street 1:302 HUSSON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3374
Practice Address - Country:US
Practice Address - Phone:207-947-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP141071363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care