Provider Demographics
NPI:1932104569
Name:UDO, REGINA GODWIN (FNP-C MSN EDS)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:GODWIN
Last Name:UDO
Suffix:
Gender:F
Credentials:FNP-C MSN EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1557 MONTE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5731
Mailing Address - Country:US
Mailing Address - Phone:575-532-5700
Mailing Address - Fax:575-532-5733
Practice Address - Street 1:1557 MONTE VISTA AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5731
Practice Address - Country:US
Practice Address - Phone:575-532-5700
Practice Address - Fax:575-532-5733
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2023-03-07
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NMCNP01155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM32D1023577OtherCLIA
NMNM016614OtherBCBS
NM92383521Medicaid
NMCNP01155OtherNM LICENSE
NMCNP01155OtherNM LICENSE
NM32D1023577OtherCLIA