Healthcare Provider Details

I. General information

NPI: 1932797370
Provider Name (Legal Business Name): CHRIS RAE WATSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 EDISON WAY
RENO NV
89502-4117
US

IV. Provider business mailing address

450 EDISON WAY
RENO NV
89502-4117
US

V. Phone/Fax

Practice location:
  • Phone: 775-858-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number10829
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: