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NPI Code Detail

MEDICARE: LYNN WATKINS RN

MEDICARE:   LYNN  WATKINS  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 NurseRN026807AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1626658OTHERAZACCESS

General Provider Information

NPI Number : 1720131477
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNN WATKINS RN
Provider Business Mailing Address
First Line : 5110 E LAFAYETTE BLVD
Second Line :
City : PHOENIX
State : AZ
Zip : 85018-4433
Country : US
Telephone Number : 480-484-2011
Fax Number : 480-484-2001
Provider Business Practice Location Address
First Line : 5110 E LAFAYETTE BLVD
Second Line :
City : PHOENIX
State : AZ
Zip : 85018-4433
Country : US
Telephone Number : 480-484-2011
Fax Number : 480-484-2001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2007
Last Update Date : 07/08/2007

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