Provider Demographics
NPI:1629007612
Name:WHITE-HEISEL, REGINA A (APRN)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:A
Last Name:WHITE-HEISEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:A
Other - Last Name:WHITE-HEISEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:7703 TRAILWOODS CT
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2723
Mailing Address - Country:US
Mailing Address - Phone:513-785-1573
Mailing Address - Fax:513-759-1567
Practice Address - Street 1:3200 VINE ST
Practice Address - Street 2:MAIL LOCATION 116A
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2213
Practice Address - Country:US
Practice Address - Phone:513-861-3100
Practice Address - Fax:513-475-6411
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN153968364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health