Provider Demographics
NPI:1730565185
Name:WATT, ERIC RAY (RN)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:RAY
Last Name:WATT
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 1:7309 E FRANKLIN CIR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55346-3818
Mailing Address - Country:US
Mailing Address - Phone:612-418-5668
Mailing Address - Fax:
Practice Address - Street 1:7309 E FRANKLIN CIR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55346-3818
Practice Address - Country:US
Practice Address - Phone:612-418-5668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-08
Last Update Date:2015-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access