Healthcare Provider Details

I. General information

NPI: 1184383010
Provider Name (Legal Business Name): DONZETTA MARIE WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 PLAIN AVE NE
CANTON OH
44714-2486
US

IV. Provider business mailing address

1324 PLAIN AVE NE
CANTON OH
44714-2486
US

V. Phone/Fax

Practice location:
  • Phone: 614-209-1308
  • Fax:
Mailing address:
  • Phone: 614-209-1308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN23508
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: