Provider Demographics
NPI:1689234148
Name:MARTIN, REGINA SUZANNE (APRN, CNM)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:SUZANNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4264 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:COVENTRY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:44203-4813
Mailing Address - Country:US
Mailing Address - Phone:330-472-2650
Mailing Address - Fax:
Practice Address - Street 1:830 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-2291
Practice Address - Country:US
Practice Address - Phone:330-684-4797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNM.019401367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife