Healthcare Provider Details

I. General information

NPI: 1548458045
Provider Name (Legal Business Name): DEBORAH L WATSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 E ASHURST DR
PHOENIX AZ
85048-7899
US

IV. Provider business mailing address

3319 E ASHURST DR
PHOENIX AZ
85048-7899
US

V. Phone/Fax

Practice location:
  • Phone: 480-201-6980
  • Fax: 480-219-9769
Mailing address:
  • Phone: 480-201-6980
  • Fax: 480-219-9769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberTAP2881
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: