MEDICARE: MRS. AMANDA JOLENE WATSON RN

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	RN360381	OH

General Provider Information

NPI Number	:	1801154620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA JOLENE WATSON RN

Provider Business Mailing Address
First Line	:	2902 LONG RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44312-5534
Country	:	US
Telephone Number	:	330-410-3017
Fax Number	:

Provider Business Practice Location Address
First Line	:	2902 LONG RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44312-5534
Country	:	US
Telephone Number	:	330-410-3017
Fax Number	:

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

Provider Enumeration Date	:	04/30/2012
Last Update Date	:	04/30/2012

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