Healthcare Provider Details

I. General information

NPI: 1881566834
Provider Name (Legal Business Name): VENUS WATSON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 CHESTNUT ST STE 876
PHILADELPHIA PA
19106-2614
US

IV. Provider business mailing address

108 E WALNUT LN
PHILADELPHIA PA
19144-2005
US

V. Phone/Fax

Practice location:
  • Phone: 215-550-1793
  • Fax:
Mailing address:
  • Phone: 215-550-1793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN322150
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: