Provider Demographics
NPI:1538484589
Name:WATSON, NANCY G (CN)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:G
Last Name:WATSON
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 RINCON DR UNIT 103-1B
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8424
Mailing Address - Country:US
Mailing Address - Phone:805-727-1097
Mailing Address - Fax:
Practice Address - Street 1:45 RINCON DR UNIT 103-1B
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8424
Practice Address - Country:US
Practice Address - Phone:805-727-1097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7047133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist