Provider Demographics
NPI:1730814534
Name:WATTS, LUANN (PMHNP BC)
Entity type:Individual
Prefix:MRS
First Name:LUANN
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:PMHNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6987 N KREPPS RD
Mailing Address - Street 2:
Mailing Address - City:ELSIE
Mailing Address - State:MI
Mailing Address - Zip Code:48831-9745
Mailing Address - Country:US
Mailing Address - Phone:989-307-2723
Mailing Address - Fax:
Practice Address - Street 1:6987 N KREPPS RD
Practice Address - Street 2:
Practice Address - City:ELSIE
Practice Address - State:MI
Practice Address - Zip Code:48831-9745
Practice Address - Country:US
Practice Address - Phone:989-307-2723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704302562363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health