Provider Demographics
NPI:1992597793
Name:WATTS, JENNA RAE (RN)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:RAE
Last Name:WATTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2515
Mailing Address - Country:US
Mailing Address - Phone:631-505-8237
Mailing Address - Fax:
Practice Address - Street 1:1067 ISAACS AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2040
Practice Address - Country:US
Practice Address - Phone:509-525-5561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60773657163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice