Provider Demographics
NPI:1770524894
Name:WATSON, LOUANNE (CNM)
Entity type:Individual
Prefix:
First Name:LOUANNE
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:LOUANNE
Other - Middle Name:
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:3180 CENTER ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4532
Mailing Address - Country:US
Mailing Address - Phone:503-588-5351
Mailing Address - Fax:503-361-2666
Practice Address - Street 1:861 MEDICAL CENTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2752
Practice Address - Country:US
Practice Address - Phone:503-364-3787
Practice Address - Fax:503-763-3595
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR099007252N5367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR292228OtherOMAP NUMBER
OR597250Medicare UPIN
OR0000WCZBCMedicare ID - Type Unspecified