Healthcare Provider Details

I. General information

NPI: 1558651323
Provider Name (Legal Business Name): REGINA GALE WILLIAMSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 N PLAZA BLVD
CHILLICOTHEE OH
45601-1757
US

IV. Provider business mailing address

72 N PLAZA BLVD
CHILLICOTHEE OH
45601-1757
US

V. Phone/Fax

Practice location:
  • Phone: 740-851-4400
  • Fax:
Mailing address:
  • Phone: 740-851-4400
  • Fax: 740-851-5503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number00025779
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number023774
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: