Provider Demographics
NPI:1790198083
Name:WATSON, JANET (RN PHN IBCLC)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:RN PHN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17170 MOUNT ELIZABETH DR
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-9546
Mailing Address - Country:US
Mailing Address - Phone:510-557-7690
Mailing Address - Fax:
Practice Address - Street 1:17170 MOUNT ELIZABETH DR
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-9546
Practice Address - Country:US
Practice Address - Phone:510-557-7690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA418433163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant