Healthcare Provider Details

I. General information

NPI: 1013504505
Provider Name (Legal Business Name): CATHERINE ANN WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 E 35TH ST
MINNEAPOLIS MN
55408-4580
US

IV. Provider business mailing address

16643 BYWOOD LN
MINNETONKA MN
55345-2606
US

V. Phone/Fax

Practice location:
  • Phone: 612-827-7181
  • Fax:
Mailing address:
  • Phone: 612-387-5853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number6511
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: