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NPI Code Detail

MEDICARE: BRENDA WATTS RN

MEDICARE:   BRENDA  WATTS  RN
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
1163W00000XRegistered NurseRN74069NV

General Provider Information

NPI Number : 1619365525
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENDA WATTS RN
Provider Business Mailing Address
First Line : 6313 LEGEND FALLS ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89081-6620
Country : US
Telephone Number : 702-945-7570
Fax Number : 702-852-5747
Provider Business Practice Location Address
First Line : 6313 LEGEND FALLS ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89081-6620
Country : US
Telephone Number : 702-945-7570
Fax Number : 702-852-5747
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2014
Last Update Date : 12/30/2014

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