Provider Demographics
NPI:1730457508
Name:WATSON, GWEN ELIZABETH (RNMS)
Entity Type:Individual
Prefix:MRS
First Name:GWEN
Middle Name:ELIZABETH
Last Name:WATSON
Suffix:
Gender:F
Credentials:RNMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 FROST MILL RD
Mailing Address - Street 2:
Mailing Address - City:MILL NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11765-1102
Mailing Address - Country:US
Mailing Address - Phone:516-922-4100
Mailing Address - Fax:516-922-0203
Practice Address - Street 1:40 FROST MILL RD
Practice Address - Street 2:
Practice Address - City:MILL NECK
Practice Address - State:NY
Practice Address - Zip Code:11765-1102
Practice Address - Country:US
Practice Address - Phone:516-922-4100
Practice Address - Fax:516-922-0203
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298565163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool