=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518594639
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERYL L. E. WATSON MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2020
-----------------------------------------------------
Last Update Date | 09/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4800 COLLEGE ST SE
-----------------------------------------------------
City | LACEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98503-4389
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-413-4250
-----------------------------------------------------
Fax | 360-412-2262
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4800 COLLEGE ST SE
-----------------------------------------------------
City | LACEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98503-4389
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-413-4250
-----------------------------------------------------
Fax | 360-412-2262
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | MD61662626
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------