Healthcare Provider Details

I. General information

NPI: 1861797409
Provider Name (Legal Business Name): CORINE SAMANTHA WATSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 W SUNSET RD
HENDERSON NV
89014-6633
US

IV. Provider business mailing address

3771 MOSS RIDGE CT
LAS VEGAS NV
89147-6812
US

V. Phone/Fax

Practice location:
  • Phone: 702-486-7353
  • Fax:
Mailing address:
  • Phone: 702-759-5774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN48449
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: