Provider Demographics
NPI:1780287755
Name:WATSON, ABBYGALE NICOLE
Entity type:Individual
Prefix:
First Name:ABBYGALE
Middle Name:NICOLE
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 1:2960 STONEY HILL RD SW
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8555
Mailing Address - Country:US
Mailing Address - Phone:740-409-1130
Mailing Address - Fax:
Practice Address - Street 1:2960 STONEY HILL RD SW
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8555
Practice Address - Country:US
Practice Address - Phone:740-409-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker