Provider Demographics
NPI:1073363891
Name:WATSON, NICHOLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 S MICHIGAN AVE APT 4002
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3702
Mailing Address - Country:US
Mailing Address - Phone:773-663-1172
Mailing Address - Fax:
Practice Address - Street 1:1160 S MICHIGAN AVE APT 4002
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-3702
Practice Address - Country:US
Practice Address - Phone:773-663-1172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILF01241445363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily