Provider Demographics
NPI:1396178992
Name:WATSON, LINDA LUCKY X (RN)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:LUCKY
Last Name:WATSON
Suffix:X
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 1:11545 N FRANK LLOYD WRIGHT BOULAVARD
Mailing Address - Street 2:APT 2050
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-2717
Mailing Address - Country:US
Mailing Address - Phone:904-945-5009
Mailing Address - Fax:
Practice Address - Street 1:11545 N FRANK LLOYD WRIGHT BLVD
Practice Address - Street 2:APT 2050
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-3141
Practice Address - Country:US
Practice Address - Phone:904-945-5009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246661-1163WC0400X
AZRN111928163WC1500X, 163WG0000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZRN111928OtherARIZONA REGISTERED NURSE LICENSE NUMBER AZ RN 111928
NY246661-1OtherREGISTERED NIRSE LICENSE