Provider Demographics
NPI:1063694982
Name:WATKINS, AMY LYNNE (RN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNNE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNNE
Other - Last Name:COLTVET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2900 PIEDMONT AVE
Mailing Address - Street 2:SUPERIORHEALTH CENTER
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2915
Mailing Address - Country:US
Mailing Address - Phone:218-727-8228
Mailing Address - Fax:218-727-7771
Practice Address - Street 1:2900 PIEDMONT AVE
Practice Address - Street 2:SUPERIORHEALTH CENTER
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-2915
Practice Address - Country:US
Practice Address - Phone:218-727-8228
Practice Address - Fax:218-727-7771
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 165493-4163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse