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General NPI Number Information
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NPI Number | 1740516871
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Entity Type | Individual
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Provider Name | NANCY LOUISE WATKINS MPT
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Gender | Female
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Dates
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Enumeration Date | 10/24/2009
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Last Update Date | 10/24/2009
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Provider Practice Location Address
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Address Line | 4401 HARRISON BLVD
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City | OGDEN
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State | UT
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Zip | 84403-3195
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Country | US
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Telephone | 801-387-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 370 S 200 W
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City | HYRUM
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State | UT
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Zip | 84319-1538
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Country | US
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Telephone | 435-245-7650
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 7209192-2401
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 22665
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License Number State | CA
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