MEDICARE: MRS. ELIZABETH M. WATSON RD

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	133V00000X	Registered Dietitian	804503

General Provider Information

NPI Number	:	1649264789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH M. WATSON RD

Provider Business Mailing Address
First Line	:	PSC 41 BOX 5784
Second Line	:
City	:	APO
State	:	AE
Zip	:	09464
Country	:	GB
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 41 BOX 5784
Second Line	:
City	:	APO
State	:	AE
Zip	:	09464
Country	:	GB
Telephone Number	:	01638528519
Fax Number	:

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	07/08/2007

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