Provider Demographics
NPI:1558512780
Name:WATSON, JENNIFER L
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
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 1:2038 CARMEL RD
Mailing Address - Street 2:CUMBERLAND COUNTY GUIDANCE CENTER
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-9754
Mailing Address - Country:US
Mailing Address - Phone:856-691-8579
Mailing Address - Fax:856-691-8625
Practice Address - Street 1:2038 CARMEL RD
Practice Address - Street 2:CUMBERLAND COUNTY GUIDANCE CENTER
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-9754
Practice Address - Country:US
Practice Address - Phone:856-691-8579
Practice Address - Fax:856-691-8625
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR12244500163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse