Provider Demographics
NPI:1740063155
Name:WATTS, MICHAELA (ND)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-6081 ALII DR APT Q201
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-4332
Mailing Address - Country:US
Mailing Address - Phone:808-333-6747
Mailing Address - Fax:
Practice Address - Street 1:75-6081 ALII DR APT Q201
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-4332
Practice Address - Country:US
Practice Address - Phone:808-333-6747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIND-356175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath