Provider Demographics
NPI:1750062840
Name:WATSON, CHAUNTIE
Entity type:Individual
Prefix:
First Name:CHAUNTIE
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 1:242 S HAZELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-2719
Mailing Address - Country:US
Mailing Address - Phone:234-313-8984
Mailing Address - Fax:234-313-8984
Practice Address - Street 1:242 S HAZELWOOD AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-2719
Practice Address - Country:US
Practice Address - Phone:234-313-8984
Practice Address - Fax:234-313-8984
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide