Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | F1112 | SC |
N | 363LW0102X | Nurse Practitioner - Women's Health | F1112 | SC |
NPI | 1083785018 |
---|---|
Provider Name | Paula J Watt |
First Address | Clemson, SC 29634-0001 |
Second Address | Clemson, SC 29634-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 06/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S90781 | (02) | SC |