Provider Demographics
NPI:1003591793
Name:WATTS, HEATHER MONNELL
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MONNELL
Last Name:WATTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 SEABROOK RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-3531
Mailing Address - Country:US
Mailing Address - Phone:937-606-8141
Mailing Address - Fax:
Practice Address - Street 1:1627 SEABROOK RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-3531
Practice Address - Country:US
Practice Address - Phone:937-606-8141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver