Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301095745 | MI |
N | 208600000X | Surgeon | 4301095745 | MI |
Y | 2086S0102X | Surgical Critical Care | 0101257513 | VA |
NPI | 1023224284 |
---|---|
Provider Name | Jill Bianca Watras |
First Address | Fairfax Station, VA 22039-1305 |
Second Address | Falls Church, VA 22042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 09/12/2020 |