Provider Demographics
NPI:1043016801
Name:WATKINS, LISA LAVETTE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LAVETTE
Last Name:WATKINS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 S 26TH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-4141
Mailing Address - Country:US
Mailing Address - Phone:712-326-4664
Mailing Address - Fax:
Practice Address - Street 1:523 S 26TH AVE APT 1
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-4141
Practice Address - Country:US
Practice Address - Phone:712-326-4664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant