Provider Demographics
NPI:1396160347
Name:WATHEN, TIMOTHY (RN)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:WATHEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 W CHARLESTON BLVD
Mailing Address - Street 2:BLDG 1
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1126
Mailing Address - Country:US
Mailing Address - Phone:702-486-6054
Mailing Address - Fax:702-486-0417
Practice Address - Street 1:6161 W CHARLESTON BLVD
Practice Address - Street 2:BLDG 1
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1126
Practice Address - Country:US
Practice Address - Phone:702-486-6054
Practice Address - Fax:702-486-0417
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN25241163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse