MEDICARE: OLIVIA FASSINO WATSON

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	L007363	NC

General Provider Information

NPI Number	:	1720772254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA FASSINO WATSON

Provider Business Mailing Address
First Line	:	105 TRIDENT CT
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27518-8692
Country	:	US
Telephone Number	:	949-241-9008
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 NEW BERN AVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1231
Country	:	US
Telephone Number	:	919-350-8000
Fax Number	:

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

Provider Enumeration Date	:	06/07/2023
Last Update Date	:	02/03/2026

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