Basic Information
| Provider Information | |||||||||
| NPI: | 1215156237 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATTS | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | SA/CSFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 76510 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809706510 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1322 N ACADEMY BLVD | ||||||||
| Address2: | STE 204 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809093317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196388844 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2007 | ||||||||
| LastUpdateDate: | 06/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZC0007X | 95324 | CO | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant |
No ID Information.