Provider Demographics
NPI:1093030678
Name:NORMAN WATKINS, CORTINA (ADMINSTRATOR)
Entity Type:Individual
Prefix:
First Name:CORTINA
Middle Name:
Last Name:NORMAN WATKINS
Suffix:
Gender:F
Credentials:ADMINSTRATOR
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 711
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28151-0711
Mailing Address - Country:US
Mailing Address - Phone:704-313-7086
Mailing Address - Fax:
Practice Address - Street 1:107 BRETT DR
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-9107
Practice Address - Country:US
Practice Address - Phone:704-313-7086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFLC-023-040376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator