Provider Demographics
NPI:1073315362
Name:WATTS, LAKEETA (DMN)
Entity type:Individual
Prefix:
First Name:LAKEETA
Middle Name:
Last Name:WATTS
Suffix:
Gender:
Credentials:DMN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:THIENSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53092-1511
Mailing Address - Country:US
Mailing Address - Phone:262-505-7811
Mailing Address - Fax:
Practice Address - Street 1:120 S ORCHARD ST
Practice Address - Street 2:
Practice Address - City:THIENSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53092-1511
Practice Address - Country:US
Practice Address - Phone:262-505-7811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLEHP1276175F00000X
171M00000X, 172V00000X
WI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No374J00000XNursing Service Related ProvidersDoula