Individual
MISS JACLYN DETA WATTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSN, RN
Contact information
Practice address
6555 PAW VILLAGE RD, CHARLOTTE, NC 28214-5607
(336) 324-7372
Mailing address
6555 PAW VILLAGE RD, CHARLOTTE, NC 28214-5607
(336) 324-7372
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
271282
NC
Other
Enumeration date
06/28/2021
Last updated
06/28/2021
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