MEDICARE: ANTRICA LYNNIECE WATKINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker

General Provider Information

NPI Number	:	1255046462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTRICA LYNNIECE WATKINS

Provider Business Mailing Address
First Line	:	1800 N MCCORD RD APT 45
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-3091
Country	:	US
Telephone Number	:	419-280-7425
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 N MCCORD RD APT 45
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-3091
Country	:	US
Telephone Number	:	419-280-7425
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2023
Last Update Date	:	01/23/2023

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