Provider Demographics
NPI:1770675837
Name:WATSON, DONNA S (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:S
Last Name:WATSON
Suffix:
Gender:F
Credentials:ARNP
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 305
Mailing Address - Street 2:
Mailing Address - City:FOX ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98333-0305
Mailing Address - Country:US
Mailing Address - Phone:253-549-4315
Mailing Address - Fax:
Practice Address - Street 1:1802 YAKIMA AVE STE 204
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5304
Practice Address - Country:US
Practice Address - Phone:253-383-3325
Practice Address - Fax:253-572-7875
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005299363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9635905Medicaid
WA9635905Medicaid
WAP82734Medicare UPIN