Provider Demographics
NPI:1861741472
Name:WATTS, CAROLYN SUE (RN)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:SUE
Last Name:WATTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:SUE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4471 MILBURN RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-6049
Mailing Address - Country:US
Mailing Address - Phone:513-375-0207
Mailing Address - Fax:
Practice Address - Street 1:4471 MILBURN RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-6049
Practice Address - Country:US
Practice Address - Phone:513-375-0207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN318409163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse