Provider Demographics
NPI:1104322627
Name:SOWAH, REGINA (STNA)
Entity type:Individual
Prefix:PROF
First Name:REGINA
Middle Name:
Last Name:SOWAH
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:MRS
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:SOWAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RENINA LARYEA
Mailing Address - Street 1:6839 PARK VISTA RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-3716
Mailing Address - Country:US
Mailing Address - Phone:937-856-2576
Mailing Address - Fax:
Practice Address - Street 1:6839 PARK VISTA RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-3716
Practice Address - Country:US
Practice Address - Phone:937-856-2576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide