Healthcare Provider Details

I. General information

NPI: 1912001272
Provider Name (Legal Business Name): CHERYL J WATTS LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 MARTIN LUTHER KING BLVD
SACRAMENTO CA
95817
US

IV. Provider business mailing address

1287 BRANWOOD WAY
SACRAMENTO CA
95831-4033
US

V. Phone/Fax

Practice location:
  • Phone: 916-875-2995
  • Fax: 916-875-2921
Mailing address:
  • Phone: 916-422-7053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN166103
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: