Healthcare Provider Details

I. General information

NPI: 1447519558
Provider Name (Legal Business Name): MELINDA J WATSON RN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CALDWELL RD
AUGUSTA ME
04330-5739
US

IV. Provider business mailing address

67 EUSTIS PKWY
WATERVILLE ME
04901-5173
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-2136
  • Fax:
Mailing address:
  • Phone: 207-660-4549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number13-115312-092
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: