Provider Demographics
NPI:1376817718
Name:WATSON, WHITNEY L
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:L
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:LEE
Other - Last Name:BONETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12836 OLD GLENN HWY
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7041
Mailing Address - Country:US
Mailing Address - Phone:907-696-0123
Mailing Address - Fax:907-696-0124
Practice Address - Street 1:12836 OLD GLENN HWY
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7041
Practice Address - Country:US
Practice Address - Phone:907-696-0123
Practice Address - Fax:907-694-0124
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK953276171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator