Provider Demographics
NPI:1104609031
Name:WATSON, JULIANNE (CNM)
Entity type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JULIANNE
Other - Middle Name:
Other - Last Name:MCGRAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:704 N BANK RD
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-9560
Mailing Address - Country:US
Mailing Address - Phone:541-817-9239
Mailing Address - Fax:
Practice Address - Street 1:704 N BANK RD
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-9560
Practice Address - Country:US
Practice Address - Phone:541-817-9239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10013911367A00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500825272Medicaid