Provider Demographics
NPI:1518050681
Name:WATKINS, MARILYN (CRNP)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CONVENTION AVE
Mailing Address - Street 2:4 PENN TOWER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4311
Mailing Address - Country:US
Mailing Address - Phone:215-662-6488
Mailing Address - Fax:
Practice Address - Street 1:1 CONVENTION AVE
Practice Address - Street 2:4 PENN TOWER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4311
Practice Address - Country:US
Practice Address - Phone:215-662-6488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP002326C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS46993Medicare UPIN