Provider Demographics
NPI:1760496673
Name:WATTS, NANCY JANE (RN)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JANE
Last Name:WATTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:474 GREAT WEST AVENUE
Mailing Address - Street 2:POB 2009
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147
Mailing Address - Country:US
Mailing Address - Phone:970-264-0990
Mailing Address - Fax:505-759-7294
Practice Address - Street 1:12000 STONE LAKE
Practice Address - Street 2:
Practice Address - City:DULCE
Practice Address - State:NM
Practice Address - Zip Code:87528
Practice Address - Country:US
Practice Address - Phone:505-759-3291
Practice Address - Fax:505-759-7249
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR36235163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000K3526Medicaid
NMHSZ196OtherMEDICARE PART B
NM320057Medicare Oscar/Certification