Healthcare Provider Details

I. General information

NPI: 1164186177
Provider Name (Legal Business Name): RACHEL WATKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9720 S TACOMA WAY
LAKEWOOD WA
98499-4456
US

IV. Provider business mailing address

9720 S TACOMA WAY
LAKEWOOD WA
98499-4456
US

V. Phone/Fax

Practice location:
  • Phone: 253-304-7753
  • Fax:
Mailing address:
  • Phone: 253-304-7753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP61205896
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: