Provider Demographics
NPI:1245883065
Name:WATKINS, LIZA (LAC)
Entity type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:23908 JANBEALL CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-9205
Mailing Address - Country:US
Mailing Address - Phone:240-686-5196
Mailing Address - Fax:
Practice Address - Street 1:13217 EXECUTIVE PARK TER
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2647
Practice Address - Country:US
Practice Address - Phone:240-686-5196
Practice Address - Fax:844-579-0086
Is Sole Proprietor?:No
Enumeration Date:2019-07-21
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02628171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist