Provider Demographics
NPI:1912001272
Name:WATTS, CHERYL J (LVN)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:J
Last Name:WATTS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1287 BRANWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-4033
Mailing Address - Country:US
Mailing Address - Phone:916-422-7053
Mailing Address - Fax:
Practice Address - Street 1:3415 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:916-875-2995
Practice Address - Fax:916-875-2921
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN166103164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse