Provider Demographics
NPI:1578240016
Name:WATKINS, VICEY
Entity Type:Individual
Prefix:MS
First Name:VICEY
Middle Name:
Last Name:WATKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6738 N 45TH AVE APT 115
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-3516
Mailing Address - Country:US
Mailing Address - Phone:989-890-5260
Mailing Address - Fax:
Practice Address - Street 1:6738 N 45TH AVE APT 115
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-3516
Practice Address - Country:US
Practice Address - Phone:989-890-5260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty