Provider Demographics
NPI:1306299045
Name:WATSON, LINDA VIENNA (CNA)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:VIENNA
Last Name:WATSON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1298
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-1298
Mailing Address - Country:US
Mailing Address - Phone:860-457-8988
Mailing Address - Fax:
Practice Address - Street 1:13 ROGERS DR
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759-3621
Practice Address - Country:US
Practice Address - Phone:860-457-8988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 310221376K00000X
CTNA81546376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide