Individual
MARY WATTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
28500 ORCHARD LAKE RD, FARMINGTON HILLS, MI 48334-2936
(952) 442-9770
Mailing address
PO BOX 67000, DEPT 203401, DETROIT, MI 48267-0002
(952) 442-9770
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704105626
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MW105626
BLUE CROSS OF MI
MI
Enumeration date
01/20/2006
Last updated
08/17/2007
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