Provider Demographics
NPI:1386424281
Name:WATSON, PATRICIA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name: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 1:11076 TECUMSEH PATH
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:OH
Mailing Address - Zip Code:43331-9247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11076 TECUMSEH PATH
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:OH
Practice Address - Zip Code:43331-9247
Practice Address - Country:US
Practice Address - Phone:937-441-9421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide