Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 242922 | AZ |
NPI | 1093327470 |
---|---|
Provider Name | Dr. Edie Watson |
First Address | Phoenix, AZ 85006-2603 |
Second Address | Phoenix, AZ 85006-2603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2020 |
Last Update Date | 15/09/2020 |