Provider Demographics
NPI:1619169752
Name:IYAWE, REGINA EDAMWEN (MSN APRN FNP-BC FNP)
Entity Type:Individual
Prefix:MISS
First Name:REGINA
Middle Name:EDAMWEN
Last Name:IYAWE
Suffix:
Gender:F
Credentials:MSN APRN FNP-BC FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-5119
Mailing Address - Country:US
Mailing Address - Phone:214-440-7151
Mailing Address - Fax:844-837-1906
Practice Address - Street 1:372 RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-5119
Practice Address - Country:US
Practice Address - Phone:214-440-7151
Practice Address - Fax:844-837-1906
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX738171372500000X
TX1056729363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No372500000XNursing Service Related ProvidersChore Provider