Provider Demographics
NPI:1083791164
Name:NIXON, REGINA LEE
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:LEE
Last Name:NIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:REGINA
Other - Middle Name:LEE
Other - Last Name:SHERRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14864 HOCK HOCKING DR
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138
Mailing Address - Country:US
Mailing Address - Phone:740-216-0579
Mailing Address - Fax:740-385-4616
Practice Address - Street 1:14864 HOCK HOCKING RD
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-8506
Practice Address - Country:US
Practice Address - Phone:740-216-0579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
2173035Medicare UPIN