Provider Demographics
NPI:1346698032
Name:WATKINS, MARILYN JOANNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:JOANNE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5199 NW ELM AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-8898
Mailing Address - Country:US
Mailing Address - Phone:541-350-6463
Mailing Address - Fax:541-923-6462
Practice Address - Street 1:5199 NW ELM AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-8898
Practice Address - Country:US
Practice Address - Phone:541-350-6463
Practice Address - Fax:541-923-6462
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR089003112RN163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant