Provider Demographics
NPI:1770866584
Name:WATKINS, SANDRA DENISE (LPN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:DENISE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206 N 92ND ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1637
Mailing Address - Country:US
Mailing Address - Phone:414-793-0880
Mailing Address - Fax:
Practice Address - Street 1:4206 N 92ND ST APT 2
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1637
Practice Address - Country:US
Practice Address - Phone:414-793-0880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI303146-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse