Provider Demographics
NPI:1811145279
Name:SAFDAR, REGINA ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:ANN
Last Name:SAFDAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1456 PARK AVE W STE N
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-2790
Mailing Address - Country:US
Mailing Address - Phone:419-529-4602
Mailing Address - Fax:419-529-4664
Practice Address - Street 1:1456 PARK AVE W STE N
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-2790
Practice Address - Country:US
Practice Address - Phone:419-529-4602
Practice Address - Fax:419-529-4664
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 234929163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care