Provider Demographics
NPI:1518295716
Name:KINUTHIA, REGINA W (CNA)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:W
Last Name:KINUTHIA
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 WYOMING BLVD NE
Mailing Address - Street 2:APT 32
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2057
Mailing Address - Country:US
Mailing Address - Phone:253-335-6564
Mailing Address - Fax:
Practice Address - Street 1:4900 WYOMING BLVD NE
Practice Address - Street 2:APT 32
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2057
Practice Address - Country:US
Practice Address - Phone:253-335-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-27
Last Update Date:2009-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM0072260309R376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide