Provider Demographics
NPI:1285118356
Name:WATSON, ANNA INGRID (MSN, APN, AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:INGRID
Last Name:WATSON
Suffix:
Gender:F
Credentials:MSN, APN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 BRISTOL LN UNIT 5
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-2817
Mailing Address - Country:US
Mailing Address - Phone:608-239-9120
Mailing Address - Fax:
Practice Address - Street 1:8425 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2202
Practice Address - Country:US
Practice Address - Phone:847-965-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.017498363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology