Provider Demographics
NPI:1609562545
Name:CROSKEY-JOHNSON, REGINA DENISE
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:DENISE
Last Name:CROSKEY-JOHNSON
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 1:451 E 156TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-1788
Mailing Address - Country:US
Mailing Address - Phone:216-466-4147
Mailing Address - Fax:
Practice Address - Street 1:451 E 156TH ST APT 2
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-1788
Practice Address - Country:US
Practice Address - Phone:216-466-4147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747A0650X
OH3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider