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General NPI Number Information
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NPI Number | 1538801188
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Entity Type | Individual
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Provider Name | LACRETIA WATTS
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Gender | Female
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 03/11/2023
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Provider Practice Location Address
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Address Line | 1055 TOWNSEND AVE
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City | NEW HAVEN
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State | CT
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Zip | 06512-1954
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Country | US
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Telephone | 203-710-2779
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Fax |
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Provider Business Mailing Address
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Address Line | 184 LIBERTY ST
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City | NEW HAVEN
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State | CT
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Zip | 06519-1625
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Country | US
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Telephone | 203-214-1924
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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 | 10299
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License Number State | CT
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