Provider Demographics
NPI:1942526678
Name:WATKINS, MCCALL LAREN (LPN)
Entity Type:Individual
Prefix:
First Name:MCCALL
Middle Name:LAREN
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 1:714 GENEVA AVE. LOWER
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43609-2950
Mailing Address - Country:US
Mailing Address - Phone:419-764-3220
Mailing Address - Fax:
Practice Address - Street 1:714 GENEVA AVE LOWR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43609-2950
Practice Address - Country:US
Practice Address - Phone:419-764-3220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 129412164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse