Provider Demographics
NPI:1144495656
Name:WATSON, ANTHONY (RN)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:WATSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4183 EAGLE WATCH WAY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-8035
Mailing Address - Country:US
Mailing Address - Phone:937-474-6817
Mailing Address - Fax:
Practice Address - Street 1:4183 EAGLE WATCH WAY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-8035
Practice Address - Country:US
Practice Address - Phone:937-474-6817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRN264902163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health