Provider Demographics
NPI:1528407194
Name:WATSON, ALICE
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
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 1:130 BIG SHOT LN
Mailing Address - Street 2:
Mailing Address - City:GASTON
Mailing Address - State:SC
Mailing Address - Zip Code:29053-8216
Mailing Address - Country:US
Mailing Address - Phone:803-463-2975
Mailing Address - Fax:
Practice Address - Street 1:130 BIG SHOT LN
Practice Address - Street 2:
Practice Address - City:GASTON
Practice Address - State:SC
Practice Address - Zip Code:29053-8216
Practice Address - Country:US
Practice Address - Phone:803-463-2975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide