Provider Demographics
NPI:1013943760
Name:WATSON, CHRISTINE R (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:R
Last Name:WATSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:
Other - Last Name:HARBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-7401
Mailing Address - Country:US
Mailing Address - Phone:815-337-7100
Mailing Address - Fax:815-337-4790
Practice Address - Street 1:2000 LAKE AVE
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-7401
Practice Address - Country:US
Practice Address - Phone:815-337-7100
Practice Address - Fax:815-337-4790
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002234363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL665231OtherHEALTHLINK PROVIDER NUMBER
IL371359450OtherFEDERAL EMPLOYER ID NUMBE
ILCB3700OtherRAILROAD MEDICARE GROUP
ILK06735OtherUMWA PROVIDER NUMBER
ILP00121463OtherRAILROAD MEDICARE PROV #
ILQ16222Medicare UPIN
ILK06735Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID NUMB
ILP00121463OtherRAILROAD MEDICARE PROV #