Healthcare Provider Details

I. General information

NPI: 1093351421
Provider Name (Legal Business Name): MICHAEL W WATSON FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 LEETSDALE DR # 220
DENVER CO
80246-1438
US

IV. Provider business mailing address

2835 CHASE ST
WHEAT RIDGE CO
80214-8433
US

V. Phone/Fax

Practice location:
  • Phone: 303-629-5293
  • Fax:
Mailing address:
  • Phone: 303-335-7714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0994856NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: