Provider Demographics
NPI:1568728434
Name:BELTON, REGINA
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:BELTON
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 1:400 PERRY ST
Mailing Address - Street 2:LOT 16
Mailing Address - City:HICKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43526-1463
Mailing Address - Country:US
Mailing Address - Phone:419-542-9717
Mailing Address - Fax:
Practice Address - Street 1:400 PERRY ST
Practice Address - Street 2:LOT 16
Practice Address - City:HICKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43526-1463
Practice Address - Country:US
Practice Address - Phone:419-542-9717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH104657615199Medicaid