Provider Demographics
NPI:1245894245
Name:WATKINS, OLIVIA RAVEEN (ND)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:RAVEEN
Last Name:WATKINS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:156 NORA MOSS LN
Mailing Address - Street 2:
Mailing Address - City:CARNESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30521-4011
Mailing Address - Country:US
Mailing Address - Phone:602-888-4405
Mailing Address - Fax:706-310-8389
Practice Address - Street 1:346 E ALVARADO RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1405
Practice Address - Country:US
Practice Address - Phone:602-888-4405
Practice Address - Fax:706-310-8389
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ191793175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath