Healthcare Provider Details

I. General information

NPI: 1518569094
Provider Name (Legal Business Name): LORI M WATSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 AIRPORT BLVD
MOBILE AL
36608-3785
US

IV. Provider business mailing address

6801 AIRPORT BLVD
MOBILE AL
36608-3785
US

V. Phone/Fax

Practice location:
  • Phone: 251-266-1000
  • Fax:
Mailing address:
  • Phone: 251-266-3580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-093110
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: