MEDICARE: RUDDISHA 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	163W00000X	Registered Nurse	746994	NY

General Provider Information

NPI Number	:	1750984027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUDDISHA WATSON

Provider Business Mailing Address
First Line	:	4142 WILDER AVE APT 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2132
Country	:	US
Telephone Number	:	718-414-9070
Fax Number	:

Provider Business Practice Location Address
First Line	:	4142 WILDER AVE APT 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2132
Country	:	US
Telephone Number	:	718-414-9070
Fax Number	:

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

Provider Enumeration Date	:	11/19/2020
Last Update Date	:	11/19/2020

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