MEDICARE: JANET WATSON R.N. PHN IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WL0100X	Lactation Consultant (Registered Nurse)	418433	CA

General Provider Information

NPI Number	:	1790198083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET WATSON R.N. PHN IBCLC

Provider Business Mailing Address
First Line	:	17170 MOUNT ELIZABETH DR
Second Line	:
City	:	SONORA
State	:	CA
Zip	:	95370-9546
Country	:	US
Telephone Number	:	510-557-7690
Fax Number	:

Provider Business Practice Location Address
First Line	:	17170 MOUNT ELIZABETH DR
Second Line	:
City	:	SONORA
State	:	CA
Zip	:	95370-9546
Country	:	US
Telephone Number	:	510-557-7690
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2014
Last Update Date	:	06/04/2014

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