MEDICARE: PEI-YU KATHERINE 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
1	367500000X	Certified Registered Nurse Anesthetist	RN179735	MD

General Provider Information

NPI Number	:	1508155730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEI-YU KATHERINE WATTS CRNA

Provider Business Mailing Address
First Line	:	4678 YORKSHIRE DR
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6504
Country	:	US
Telephone Number	:	267-303-0425
Fax Number	:

Provider Business Practice Location Address
First Line	:	4678 YORKSHIRE DR
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6504
Country	:	US
Telephone Number	:	267-303-0425
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2011
Last Update Date	:	05/13/2020

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