Provider Demographics
NPI:1710200977
Name:WATSON, DARLENE LYNNETTE (BS)
Entity Type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:LYNNETTE
Last Name:WATSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5411 COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-9179
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5411 COUNTRY CLUB LN
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-9179
Practice Address - Country:US
Practice Address - Phone:989-777-8570
Practice Address - Fax:989-777-8620
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIW 325 135 564 437247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other