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Individual
ELLYN WATTERS
Active
Individual
ELLYN WATTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1162973
IA
363A00000X
Physician Assistant
Primary
2562
NE
Other
Enumeration date
09/09/2019
Last updated
04/25/2023
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