Provider Demographics
NPI:1316151046
Name:WATTS, EARNESTINE (CNA)
Entity type:Individual
Prefix:MS
First Name:EARNESTINE
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 POTOMAC AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-1930
Mailing Address - Country:US
Mailing Address - Phone:412-668-0057
Mailing Address - Fax:
Practice Address - Street 1:2581 WASHINGTON RD
Practice Address - Street 2:SUITE 235
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-2564
Practice Address - Country:US
Practice Address - Phone:800-355-1225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA9909965376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA9909965OtherCNA CERTIFICATION