Healthcare Provider Details

I. General information

NPI: 1205268612
Provider Name (Legal Business Name): PRECIOUS WATSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 E 95TH ST
CHICAGO IL
60619-8019
US

IV. Provider business mailing address

1217 E 95TH ST
CHICAGO IL
60619-8019
US

V. Phone/Fax

Practice location:
  • Phone: 773-310-9868
  • Fax:
Mailing address:
  • Phone: 773-310-9868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number041.370606
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: