Healthcare Provider Details

I. General information

NPI: 1104912781
Provider Name (Legal Business Name): MISS MONICA J WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 ST CLAIR RIVER DRIVE
ALGONAC MI
48001
US

IV. Provider business mailing address

555 ST CLAIR RIVER DRIVE
ALGONAC MI
48001
US

V. Phone/Fax

Practice location:
  • Phone: 810-794-7548
  • Fax:
Mailing address:
  • Phone: 810-794-7548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: