Provider Demographics
NPI:1205823903
Name:WATSON, IRENE (NP)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 CHALKSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-4799
Mailing Address - Country:US
Mailing Address - Phone:401-273-7100
Mailing Address - Fax:401-457-3364
Practice Address - Street 1:830 CHALKSTONE AVE
Practice Address - Street 2:DEPT OF MEDICINE
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4799
Practice Address - Country:US
Practice Address - Phone:401-273-7100
Practice Address - Fax:401-457-3364
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP24067363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI050483739OtherTIN #