Basic Information
| Provider Information | |||||||||
| NPI: | 1790417871 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 MACK BLVD FL 4 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181035622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4843301377 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2741 MACARTHUR RD | ||||||||
| Address2: | |||||||||
| City: | WHITEHALL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180523632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104036000 | ||||||||
| FaxNumber: | 6104036010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2022 | ||||||||
| LastUpdateDate: | 09/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP025967 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | SP025967 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | SP025967 | 01 | PA | STATE LICENSE | OTHER |