Provider Demographics
NPI:1881022390
Name:WATSON, CAROLYN (EAMP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 LOWE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-2522
Mailing Address - Country:US
Mailing Address - Phone:360-441-1562
Mailing Address - Fax:
Practice Address - Street 1:1221 FRASER ST
Practice Address - Street 2:#102
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-5844
Practice Address - Country:US
Practice Address - Phone:360-392-3697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60416761171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist