Provider Demographics
NPI:1497924252
Name:WATTS, AUDREY CELESTE (CRNP)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:CELESTE
Last Name:WATTS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:CELESTE
Other - Last Name:HALLINAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:850 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-3295
Mailing Address - Country:US
Mailing Address - Phone:610-778-9297
Mailing Address - Fax:670-778-9270
Practice Address - Street 1:850 S 5TH ST
Practice Address - Street 2:5TH FLOOR BILLING
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3295
Practice Address - Country:US
Practice Address - Phone:610-778-9297
Practice Address - Fax:670-778-9270
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009585363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner