Provider Demographics
NPI:1104400936
Name:WATSON, CRYSTAL DENISE
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DENISE
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 1:1755 TOBIAS DR SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-2843
Mailing Address - Country:US
Mailing Address - Phone:202-498-2583
Mailing Address - Fax:
Practice Address - Street 1:2700 JASPER ST SE APT 149
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2063
Practice Address - Country:US
Practice Address - Phone:202-341-2087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant