Provider Demographics
NPI:1386479434
Name:WATSON, FANNIE
Entity type:Individual
Prefix:
First Name:FANNIE
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 1:1318 HIGHWAY 171
Mailing Address - Street 2:
Mailing Address - City:STONEWALL
Mailing Address - State:LA
Mailing Address - Zip Code:71078
Mailing Address - Country:US
Mailing Address - Phone:318-906-5054
Mailing Address - Fax:
Practice Address - Street 1:1318 HIGHWAY 171
Practice Address - Street 2:1318 HWY 171
Practice Address - City:STONEWALL
Practice Address - State:LA
Practice Address - Zip Code:71078
Practice Address - Country:US
Practice Address - Phone:318-906-5054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker