Provider Demographics
NPI:1235114273
Name:WATSON, ROBIN R (MSN APRN)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:R
Last Name:WATSON
Suffix:
Gender:F
Credentials:MSN APRN
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:L
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 CASE ST
Mailing Address - Street 2:STE 212
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2222
Mailing Address - Country:US
Mailing Address - Phone:860-859-9123
Mailing Address - Fax:
Practice Address - Street 1:330 WASHINGTON ST
Practice Address - Street 2:EASTERN CT HEMATOLOGY & ONCOLOGY SUITE 220
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2700
Practice Address - Country:US
Practice Address - Phone:860-886-8362
Practice Address - Fax:860-886-9262
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002940207RH0003X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004247145Medicaid
CT004396174OtherCHNCT
CT004247145Medicaid
CTD400008294Medicare PIN