Provider Demographics
NPI:1023490679
Name:WATSON, NEVADA
Entity type:Individual
Prefix:MS
First Name:NEVADA
Middle Name:
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 1:3705 S GEORGE MASON DR APT 1115
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-4777
Mailing Address - Country:US
Mailing Address - Phone:202-492-2991
Mailing Address - Fax:
Practice Address - Street 1:3705 S GEORGE MASON DR APT 1115
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-4777
Practice Address - Country:US
Practice Address - Phone:202-492-2991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260021322255A2300X
FLAL 39172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer