Basic Information
| Provider Information | |||||||||
| NPI: | 1770230971 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATTS | ||||||||
| FirstName: | SHAWNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 S AVENUE A | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853647170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283361801 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1390 W 16TH ST | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853644430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283444325 | ||||||||
| FaxNumber: | 9283443084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2022 | ||||||||
| LastUpdateDate: | 06/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN201220 | AZ | N | Nursing Service Providers | Registered Nurse | 363LA2100X | 272920 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.