Provider Demographics
NPI:1699464776
Name:WATTIER, DENNIS L JR (RN)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:L
Last Name:WATTIER
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20293 STOCKBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-7947
Mailing Address - Country:US
Mailing Address - Phone:205-409-8699
Mailing Address - Fax:
Practice Address - Street 1:20293 STOCKBRIDGE WAY
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-7947
Practice Address - Country:US
Practice Address - Phone:208-409-8699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-43737207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine