Provider Demographics
NPI:1497163133
Name:HOLLANDSWORTH, REGINA L
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:L
Last Name:HOLLANDSWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 PARRISH AVE
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF INDIAN SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45015-1250
Mailing Address - Country:US
Mailing Address - Phone:513-418-3239
Mailing Address - Fax:513-896-1841
Practice Address - Street 1:1941 PARRISH AVE
Practice Address - Street 2:
Practice Address - City:VILLAGE OF INDIAN SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45015-1250
Practice Address - Country:US
Practice Address - Phone:513-418-3239
Practice Address - Fax:513-896-1841
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide