Healthcare Provider Details

I. General information

NPI: 1114064128
Provider Name (Legal Business Name): REGINA M O'LEARY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 MARKET ST
BOARDMAN OH
44512-3457
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 330-480-2363
  • Fax: 330-480-6359
Mailing address:
  • Phone: 330-480-2363
  • Fax: 330-480-6359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP010426
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberSP001256J
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAPRN.CNP.020627
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: