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NPI Code Detail

MEDICARE: MARY JO WATTS CRNA

MEDICARE: MARY JO WATTS CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist794938TX

General Provider Information

NPI Number : 1427166040
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY JO WATTS CRNA
Provider Business Mailing Address
First Line : 1245 PRAIRIE BND STE 900
Second Line :
City : NEW BRAUNFELS
State : TX
Zip : 78132-2966
Country : US
Telephone Number : 757-813-7988
Fax Number :
Provider Business Practice Location Address
First Line : 403 TREELINE PARK
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78209-2042
Country : US
Telephone Number : 210-294-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2006
Last Update Date : 03/06/2023

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