1740517374 NPI number — MEGAN E WATTS- ST. GERMAIN APRN

Table of content: MEGAN E WATTS- ST. GERMAIN APRN (NPI 1740517374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740517374 NPI number — MEGAN E WATTS- ST. GERMAIN APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATTS- ST. GERMAIN
Provider First Name:
MEGAN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WATTS
Provider Other First Name:
MEGAN
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740517374
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 LORENZ INDUSTRIAL PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEDYARD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06339-1946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-464-3045
Provider Business Mailing Address Fax Number:
860-464-3044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
365 MONTAUK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW LONDON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06320-4700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-442-0711
Provider Business Practice Location Address Fax Number:
860-444-4767
Provider Enumeration Date:
11/03/2009

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: 363LP0808X , with the licence number:  R39531 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com