Provider Demographics
NPI:1003162751
Name:WATSON, STEPHANIE RENEE
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:RENEE
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 1:1512 TOBIAS DR SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-2955
Mailing Address - Country:US
Mailing Address - Phone:202-903-8439
Mailing Address - Fax:
Practice Address - Street 1:1512 TOBIAS DR SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2955
Practice Address - Country:US
Practice Address - Phone:202-903-8439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide