Healthcare Provider Details

I. General information

NPI: 1285118356
Provider Name (Legal Business Name): ANNA INGRID WATSON MSN, APN, AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8425 WAUKEGAN RD
MORTON GROVE IL
60053-2202
US

IV. Provider business mailing address

143 BRISTOL LN UNIT 5
WOOD DALE IL
60191-2817
US

V. Phone/Fax

Practice location:
  • Phone: 847-965-8100
  • Fax:
Mailing address:
  • Phone: 608-239-9120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209.017498
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: