Provider Demographics
NPI:1578844916
Name:WATSON, WENDY MICHELLE (LPN-NURSE)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:MICHELLE
Last Name:WATSON
Suffix:
Gender:F
Credentials:LPN-NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 E MOORE ST
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4826
Mailing Address - Country:US
Mailing Address - Phone:501-268-7777
Mailing Address - Fax:501-278-5506
Practice Address - Street 1:3204 E MOORE ST
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4826
Practice Address - Country:US
Practice Address - Phone:501-268-7777
Practice Address - Fax:501-278-5506
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL49060164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse