Individual
MARYJO A WATKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
155 MEMORIAL DR, ANESTHESIA DEPT, PINEHURST, NC 28374-8710
(910) 715-1235
Mailing address
PO BOX 99, LEWISVILLE, NC 27023-0099
(731) 234-2335
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
10681
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00013859
NHC CARE ADMINISTRATORS
—
01
—
278219
ANTHEM BCBS
—
05
—
3627252
—
TN
01
—
4053056
BLUE SHIELD OF TN
TN
05
—
74005992
—
KY
01
—
TN0100
JOHN DEERE
—
Enumeration date
09/02/2005
Last updated
07/08/2007
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