Provider Demographics
NPI:1013346279
Name:WATKINS, DEMETRIUS (STNA)
Entity Type:Individual
Prefix:
First Name:DEMETRIUS
Middle Name:
Last Name:WATKINS
Suffix:
Gender:M
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 RICHMOND PARK E
Mailing Address - Street 2:A222
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1813
Mailing Address - Country:US
Mailing Address - Phone:440-565-7596
Mailing Address - Fax:
Practice Address - Street 1:446 RICHMOND PARK E
Practice Address - Street 2:A222
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-1813
Practice Address - Country:US
Practice Address - Phone:440-565-7596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400715510208374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide