Doctor Name: | SHEILA WATSON |
NPI Number: | 1043614035 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-BC |
License Number: | 28146617A |
Business Practice Address: | 3170 Willowcreek Rd Portage, IN - 463684424 |
Business Phone Number: | 2199476628 |
Business Fax Number: | |
Mailing Address: | 3170 Willowcreek Rd, PORTAGE |
State: | IN |
Postal Code: | 463684424 |
Phone Number: | 2199476628 |
Fax Number: | |
NPI Enumeration Date: | 10/20/2014 |
NPI Last Update Date: | 10/20/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 28146617A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |