Provider Demographics
NPI:1194058909
Name:KAHNERT, REGINA MARIE (CNP)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:KAHNERT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-609-1112
Mailing Address - Fax:419-502-3511
Practice Address - Street 1:254 CLEVELAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001
Practice Address - Country:US
Practice Address - Phone:440-455-3090
Practice Address - Fax:440-984-7182
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10843363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH567080OtherMEDICARE
OH3020395Medicaid
OH9686455OtherAETNA