1205130564 NPI number — MS. YALEITA RENEE WATSON CNP

Table of content: MS. YALEITA RENEE WATSON CNP (NPI 1205130564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205130564 NPI number — MS. YALEITA RENEE WATSON CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATSON
Provider First Name:
YALEITA
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WATSON
Provider Other First Name:
YALEITA
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1205130564
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6681 RIDGE RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44129-5705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-842-8675
Provider Business Mailing Address Fax Number:
440-842-1299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6681 RIDGE RD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-842-8675
Provider Business Practice Location Address Fax Number:
440-842-1299
Provider Enumeration Date:
12/30/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN9244159 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: RN 321831 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: APRN.CNP.020366 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0210022 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".