Provider Demographics
NPI:1780416982
Name:EILAND, REGINA D (N/A)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:D
Last Name:EILAND
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 FULLERS CIR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-7824
Mailing Address - Country:US
Mailing Address - Phone:614-886-0459
Mailing Address - Fax:
Practice Address - Street 1:6810 E MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2217
Practice Address - Country:US
Practice Address - Phone:614-886-0459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker