Provider Demographics
NPI:1497100135
Name:WATT, CONNIE (LM)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:WATT
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:PINESDALE
Mailing Address - State:MT
Mailing Address - Zip Code:59841
Mailing Address - Country:US
Mailing Address - Phone:406-360-7277
Mailing Address - Fax:406-961-3986
Practice Address - Street 1:97 WILLOW WAY
Practice Address - Street 2:
Practice Address - City:PINESDALE
Practice Address - State:MT
Practice Address - Zip Code:59841
Practice Address - Country:US
Practice Address - Phone:406-360-7277
Practice Address - Fax:406-961-3986
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1302175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay