Healthcare Provider Details

I. General information

NPI: 1124996533
Provider Name (Legal Business Name): MARY ELLEN WATTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 338
SCOTTSDALE AZ
85252-0338
US

IV. Provider business mailing address

PO BOX 338
SCOTTSDALE AZ
85252
US

V. Phone/Fax

Practice location:
  • Phone: 480-589-2738
  • Fax:
Mailing address:
  • Phone: 480-589-2738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN155449
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: