Provider Demographics
NPI:1720805070
Name:GININWA, REGINA TORNUBARI (NP)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:TORNUBARI
Last Name:GININWA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579 BEDFORD KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-2024
Mailing Address - Country:US
Mailing Address - Phone:336-745-0585
Mailing Address - Fax:
Practice Address - Street 1:579 BEDFORD KNOLL DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-2024
Practice Address - Country:US
Practice Address - Phone:336-745-0585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024055832363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily