Provider Demographics
NPI:1356428692
Name:FORD-WATSON, LENORA ANN (FNP)
Entity type:Individual
Prefix:MRS
First Name:LENORA
Middle Name:ANN
Last Name:FORD-WATSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:LENORA
Other - Middle Name:ANN
Other - Last Name:FORD-PETERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:3032 E CHAPARRAL ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-9123
Mailing Address - Country:US
Mailing Address - Phone:909-923-7993
Mailing Address - Fax:909-923-7993
Practice Address - Street 1:928 W 40TH PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-1905
Practice Address - Country:US
Practice Address - Phone:323-235-6229
Practice Address - Fax:323-235-1157
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN319054363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP293Medicaid
CAS72148Medicare UPIN
CANP293Medicaid