Provider Demographics
NPI:1851665459
Name:WATSON, MARCIE JO (RN)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:JO
Last Name:WATSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49447 ZEP RD W
Mailing Address - Street 2:
Mailing Address - City:SARAHSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43779-9774
Mailing Address - Country:US
Mailing Address - Phone:740-581-1331
Mailing Address - Fax:
Practice Address - Street 1:49447 ZEP RD W
Practice Address - Street 2:
Practice Address - City:SARAHSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43779-9774
Practice Address - Country:US
Practice Address - Phone:740-581-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN267265163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN267265OtherNURSES LISCENSURE
OHRN267265OtherNURSES LISCENSURE