Provider Demographics
NPI:1700190436
Name:WATKINS, LISA SANFORD (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:SANFORD
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 1:3700 ROSS AVE
Mailing Address - Street 2:BOX 96
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-5422
Mailing Address - Country:US
Mailing Address - Phone:972-925-3386
Mailing Address - Fax:972-925-3387
Practice Address - Street 1:3700 ROSS AVE
Practice Address - Street 2:BOX 96
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-5422
Practice Address - Country:US
Practice Address - Phone:972-925-3386
Practice Address - Fax:972-925-3387
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX718142171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator