Healthcare Provider Details

I. General information

NPI: 1649574591
Provider Name (Legal Business Name): LYDIA ANN WATKINS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

IV. Provider business mailing address

PO BOX 13008
LANSING MI
48901-3008
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-2756
  • Fax: 517-364-2735
Mailing address:
  • Phone: 517-364-2756
  • Fax: 517-364-2735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704237993
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: