Provider Demographics
NPI:1225266042
Name:WATSON, LUCILLE DIANE (RN)
Entity Type:Individual
Prefix:MRS
First Name:LUCILLE
Middle Name:DIANE
Last Name:WATSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 S. MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402
Mailing Address - Country:US
Mailing Address - Phone:937-461-3269
Mailing Address - Fax:937-461-9584
Practice Address - Street 1:349 S. MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402
Practice Address - Country:US
Practice Address - Phone:937-461-3450
Practice Address - Fax:937-461-9584
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH100666163WM0705X
IN28143056163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical