Provider Demographics
NPI:1649935784
Name:WATFORD, DEBRA ANN
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:ANN
Last Name:WATFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5667 N 57TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-2416
Mailing Address - Country:US
Mailing Address - Phone:414-551-2066
Mailing Address - Fax:414-455-8112
Practice Address - Street 1:5667 N 57TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-2416
Practice Address - Country:US
Practice Address - Phone:414-551-2066
Practice Address - Fax:414-455-8112
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion