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General NPI Number Information
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NPI Number | 1841421716
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Entity Type | Individual
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Provider Name | GWENDOLYN GAIL WATSON LPN
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Gender | Female
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Dates
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Enumeration Date | 07/27/2009
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Last Update Date | 07/27/2009
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Provider Practice Location Address
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Address Line | 1220 VALLEYVIEW AVE SW
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City | CANTON
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State | OH
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Zip | 44710-1428
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Country | US
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Telephone | 330-546-6422
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Fax | 330-477-9143
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Provider Business Mailing Address
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Address Line | 1220 VALLEYVIEW AVE SW
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City | CANTON
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State | OH
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Zip | 44710-1428
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Country | US
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Telephone | 330-546-6422
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Fax | 330-477-9143
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN135236IV
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License Number State | OH
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