Provider Demographics
NPI:1235364175
Name:WATSON, CHERYL FAY
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:FAY
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 1:22 GREENLAND DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-3438
Mailing Address - Country:US
Mailing Address - Phone:740-366-4082
Mailing Address - Fax:
Practice Address - Street 1:22 GREENLAND DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3438
Practice Address - Country:US
Practice Address - Phone:740-366-4082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide