Provider Demographics
NPI:1730436395
Name:WOODSON, REGINA MARIE (CNP)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:WOODSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MRS
Other - First Name:REGINA
Other - Middle Name:MARIE
Other - Last Name:OUSLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4441 DUNLOE CT
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-6032
Mailing Address - Country:US
Mailing Address - Phone:419-283-0277
Mailing Address - Fax:
Practice Address - Street 1:4441 DUNLOE CT
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-6032
Practice Address - Country:US
Practice Address - Phone:419-283-0277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH323893363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH149801Medicare PIN