Provider Demographics
NPI:1548927072
Name:WATKINS, DEANA (LPN)
Entity type:Individual
Prefix:
First Name:DEANA
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 COLLINGSWORTH TRCE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-7578
Mailing Address - Country:US
Mailing Address - Phone:217-220-2356
Mailing Address - Fax:
Practice Address - Street 1:297 COLLINGSWORTH TRCE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-7578
Practice Address - Country:US
Practice Address - Phone:217-220-2356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN100086164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse