Healthcare Provider Details

I. General information

NPI: 1932104569
Provider Name (Legal Business Name): REGINA GODWIN UDO FNP-C MSN EDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

1557 MONTE VISTA AVE
LAS CRUCES NM
88001-5731
US

IV. Provider business mailing address

1557 MONTE VISTA AVE
LAS CRUCES NM
88001-5731
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-5700
  • Fax: 575-532-5733
Mailing address:
  • Phone: 575-532-5700
  • Fax: 575-532-5733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP01155
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: