Healthcare Provider Details

I. General information

NPI: 1760496673
Provider Name (Legal Business Name): NANCY JANE WATTS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 STONE LAKE
DULCE NM
87528
US

IV. Provider business mailing address

474 GREAT WEST AVENUE POB 2009
PAGOSA SPRINGS CO
81147
US

V. Phone/Fax

Practice location:
  • Phone: 505-759-3291
  • Fax: 505-759-7249
Mailing address:
  • Phone: 970-264-0990
  • Fax: 505-759-7294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR36235
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: