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General NPI Number Information
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NPI Number | 1417239393
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Entity Type | Individual
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Provider Name | CAROL DENISE WATKINS CRNP
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Gender | Male
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Dates
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Enumeration Date | 09/15/2011
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Last Update Date | 05/08/2019
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Provider Practice Location Address
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Address Line | 3330 WILKENS AVE
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City | BALTIMORE
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State | MD
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Zip | 21229-4610
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Country | US
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Telephone | 410-525-1544
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Fax |
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Provider Business Mailing Address
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Address Line | 3330 WILKENS AVE
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City | BALTIMORE
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State | MD
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Zip | 21229-4610
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Country | US
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Telephone | 410-525-1544
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R133381
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | SP019974
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License Number State | PA
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