Provider Demographics
NPI:1043827686
Name:WATTS LAPOLE, SANDRA P
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:P
Last Name:WATTS LAPOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2306
Mailing Address - Country:US
Mailing Address - Phone:304-308-8051
Mailing Address - Fax:
Practice Address - Street 1:132 OLIVE ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2306
Practice Address - Country:US
Practice Address - Phone:304-308-8051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant