Provider Demographics
NPI:1164659991
Name:WATKINS, STEPHANIE A (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:A
Last Name:WATKINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:A
Other - Last Name:MARUCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4000 NEXUS DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3000
Mailing Address - Country:US
Mailing Address - Phone:302-320-5700
Mailing Address - Fax:302-320-1261
Practice Address - Street 1:4000 NEXUS DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3000
Practice Address - Country:US
Practice Address - Phone:302-320-5700
Practice Address - Fax:302-320-1261
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015947207Q00000X
DEC2-0013289207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine