Provider Demographics
NPI:1477981934
Name:WATT FAMILY MEDICAL AND MEDICAL AESTHETICS, LLC
Entity Type:Organization
Organization Name:WATT FAMILY MEDICAL AND MEDICAL AESTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATT
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, FNP-BC
Authorized Official - Phone:765-301-9288
Mailing Address - Street 1:1003 MILL POND LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-2608
Mailing Address - Country:US
Mailing Address - Phone:765-301-9288
Mailing Address - Fax:765-301-9226
Practice Address - Street 1:1003 MILL POND LN
Practice Address - Street 2:SUITE B
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-2608
Practice Address - Country:US
Practice Address - Phone:765-301-9288
Practice Address - Fax:765-301-9226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-21
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002641A261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care