Provider Demographics
NPI:1902558133
Name:WATKINS, SHAUNA LYNN
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:LYNN
Last Name:WATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7455 W WASHINGTON AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4352
Mailing Address - Country:US
Mailing Address - Phone:701-227-3442
Mailing Address - Fax:702-776-8871
Practice Address - Street 1:7455 W WASHINGTON AVE STE 420
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-4352
Practice Address - Country:US
Practice Address - Phone:702-227-3442
Practice Address - Fax:702-776-8871
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
15726156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist