Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN054586-AP03069 | LA |
NPI | 1013916378 |
---|---|
Provider Name | Mrs. Marilyn Hopson Watson |
First Address | Lake Charles, LA 70606-4610 |
Second Address | Sulphur, LA 70663-5134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 30/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1547352 | (05) | LA |
P15685 | (02) |