Provider Demographics
NPI:1699421156
Name:MUTITIKA, REGINA NJOKI (RN)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:NJOKI
Last Name:MUTITIKA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4345 CRICKET PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-6178
Mailing Address - Country:US
Mailing Address - Phone:614-377-5595
Mailing Address - Fax:614-377-5595
Practice Address - Street 1:4345 CRICKET PL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-6178
Practice Address - Country:US
Practice Address - Phone:614-377-5595
Practice Address - Fax:614-377-5595
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.450838163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0485882Medicaid