Provider Demographics
NPI:1013770429
Name:WATSON, STEPHANIE MICHELLE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W PLATT ST
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:OH
Mailing Address - Zip Code:43845-1344
Mailing Address - Country:US
Mailing Address - Phone:740-641-8427
Mailing Address - Fax:
Practice Address - Street 1:116 W PLATT ST
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:OH
Practice Address - Zip Code:43845-1344
Practice Address - Country:US
Practice Address - Phone:740-641-8427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.461689163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse