Provider Demographics
NPI:1003823022
Name:WATSON, ANGELA ELLISE (PAC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:ELLISE
Last Name:WATSON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 HARTMAN LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1118
Mailing Address - Country:US
Mailing Address - Phone:541-334-3350
Mailing Address - Fax:541-284-5198
Practice Address - Street 1:2400 HARTMAN LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1118
Practice Address - Country:US
Practice Address - Phone:541-334-3350
Practice Address - Fax:541-284-5198
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00394363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant