Provider Demographics
NPI:1205130564
Name:WATSON, YALEITA RENEE (CNP)
Entity type:Individual
Prefix:MS
First Name:YALEITA
Middle Name:RENEE
Last Name:WATSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MS
Other - First Name:YALEITA
Other - Middle Name:RENEE
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:6681 RIDGE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5705
Mailing Address - Country:US
Mailing Address - Phone:440-842-8675
Mailing Address - Fax:440-842-1299
Practice Address - Street 1:6681 RIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129
Practice Address - Country:US
Practice Address - Phone:440-842-8675
Practice Address - Fax:440-842-1299
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9244159163W00000X
OHRN 321831163W00000X
OHAPRN.CNP.020366363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0210022Medicaid