Provider Demographics
NPI:1881257426
Name:WATKINS WOOLBRIGHT, NATHAN
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:WATKINS WOOLBRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 CAMELLIA WAY
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1519
Mailing Address - Country:US
Mailing Address - Phone:209-678-3502
Mailing Address - Fax:
Practice Address - Street 1:522 E GRANGER AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4545
Practice Address - Country:US
Practice Address - Phone:209-558-4610
Practice Address - Fax:209-558-4590
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374700000X
CAMPSS-UFEMCW175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No374700000XNursing Service Related ProvidersTechnician