Provider Demographics
NPI:1215196795
Name:WATKINS, NENA (LAC)
Entity Type:Individual
Prefix:
First Name:NENA
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3162
Mailing Address - Country:US
Mailing Address - Phone:425-478-5251
Mailing Address - Fax:
Practice Address - Street 1:543 MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3162
Practice Address - Country:US
Practice Address - Phone:425-478-5251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002160171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist