Provider Demographics
NPI:1114430238
Name:WATKINS, LI (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:LI
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:FNP-BC
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 1608
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-1608
Mailing Address - Country:US
Mailing Address - Phone:909-421-2121
Mailing Address - Fax:909-421-0491
Practice Address - Street 1:280 N RIVERSIDE AVENUE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376
Practice Address - Country:US
Practice Address - Phone:909-421-2121
Practice Address - Fax:909-421-0491
Is Sole Proprietor?:No
Enumeration Date:2017-11-10
Last Update Date:2019-02-20
Deactivation Date:2018-02-14
Deactivation Code:
Reactivation Date:2019-02-20
Provider Licenses
StateLicense IDTaxonomies
CA95006406363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily