Healthcare Provider Details

I. General information

NPI: 1205130564
Provider Name (Legal Business Name): YALEITA RENEE WATSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YALEITA RENEE WATSON RN

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6681 RIDGE RD STE 300
PARMA OH
44129
US

IV. Provider business mailing address

6681 RIDGE RD STE 300
PARMA OH
44129-5705
US

V. Phone/Fax

Practice location:
  • Phone: 440-842-8675
  • Fax: 440-842-1299
Mailing address:
  • Phone: 440-842-8675
  • Fax: 440-842-1299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.020366
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9244159
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 321831
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: