Provider Demographics
NPI:1194589333
Name:WALDREN-WATSON, SHEREE
Entity type:Individual
Prefix:
First Name:SHEREE
Middle Name:
Last Name:WALDREN-WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 PHILLIPS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-2634
Mailing Address - Country:US
Mailing Address - Phone:937-520-4206
Mailing Address - Fax:
Practice Address - Street 1:1237 PHILLIPS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-2634
Practice Address - Country:US
Practice Address - Phone:937-520-4206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker