Healthcare Provider Details

I. General information

NPI: 1689830606
Provider Name (Legal Business Name): JENNIFER MARIE WATSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 10/22/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE PEDIATRIC HOSPITALIST DIVISION
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE CHILDREN'S SPECIALTY GROUP- CHILDREN'S WISCONSIN
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-337-7050
  • Fax: 414-337-7020
Mailing address:
  • Phone: 414-337-7050
  • Fax: 414-337-7020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60507
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: