Provider Demographics
NPI:1750305496
Name:WATSON, LOUISE (CRNA)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:TX
Mailing Address - Zip Code:75563-0157
Mailing Address - Country:US
Mailing Address - Phone:903-756-5383
Mailing Address - Fax:
Practice Address - Street 1:31040 LAHSER RD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-3628
Practice Address - Country:US
Practice Address - Phone:248-646-7150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC02613367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1906590Medicaid
LA5Y180C734Medicare PIN
LAP00463336Medicare PIN