Provider Demographics
NPI:1881405959
Name:WATSON, CAMILLA EDWINA (CNA HCT)
Entity type:Individual
Prefix:
First Name:CAMILLA
Middle Name:EDWINA
Last Name:WATSON
Suffix:
Gender:
Credentials:CNA HCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 BEACON RIDGE RD APT 315
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3565
Mailing Address - Country:US
Mailing Address - Phone:980-451-6449
Mailing Address - Fax:
Practice Address - Street 1:1808 RUSH WIND DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-2307
Practice Address - Country:US
Practice Address - Phone:704-649-6449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC169816376K00000X
NC163946376K00000X
376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide