Provider Demographics
NPI:1114064128
Name:O'LEARY, REGINA M (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:M
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-480-2363
Mailing Address - Fax:330-480-6359
Practice Address - Street 1:6505 MARKET ST
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-3457
Practice Address - Country:US
Practice Address - Phone:330-480-2363
Practice Address - Fax:330-480-6359
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010426363LF0000X
PASP001256J363LN0000X
OHAPRN.CNP.020627363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA168903Medicare PIN
PA102420731Medicaid
PA002122186OtherHIGHMARK MEDICARE ADVANTAGE