Healthcare Provider Details

I. General information

NPI: 1982904348
Provider Name (Legal Business Name): CHERYL ANN WATSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14681 NE 95TH ST
REDMOND WA
98052-2556
US

IV. Provider business mailing address

14681 NE 95TH ST
REDMOND WA
98052-2556
US

V. Phone/Fax

Practice location:
  • Phone: 425-739-0700
  • Fax: 425-883-1566
Mailing address:
  • Phone: 425-739-0700
  • Fax: 425-883-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 00080234
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: