Basic Information
Provider Information
NPI: 1730571993
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WATSON
FirstName: BELINDA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 14541 W INDIAN SCHOOL RD
Address2:  
City: GOODYEAR
State: AZ
PostalCode: 853959243
CountryCode: US
TelephoneNumber: 6235355599
FaxNumber:  
Practice Location
Address1: 14541 W INDIAN SCHOOL RD
Address2:  
City: GOODYEAR
State: AZ
PostalCode: 853959243
CountryCode: US
TelephoneNumber: 6235355599
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/25/2015
LastUpdateDate: 04/28/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/28/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN126450AZN Nursing Service ProvidersRegistered Nurse 
363LF0000X247233AZY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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