Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC003169L | PA |
Y | 222Z00000X | Podiatrist | SC003169L | PA |
N | 213EP1101X | Primary Podiatric Medicine | SC003169L | PA |
N | 111NR0200X | Radiology | SC003169L | PA |
N | 213ER0200X | Radiology | SC003169L | PA |
N | 2081S0010X | Sports Medicine | SC003169L | PA |
N | 213ES0000X | Sports Medicine | SC003169L | PA |
N | 213ES0131X | Foot Surgery | SC003169L | PA |
NPI | 1619962149 |
---|---|
Provider Name | Dr. Lisa Jayne Watters |
First Address | Lower Burrell, PA 15068-2858 |
Second Address | Lower Burrell, PA 15068-2858 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 16/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T30472 | (02) | PA |