Individual
MYSTIQUE WATSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
56 ERIN ST, WHITMAN, MA 02382-2432
(508) 933-5013
Mailing address
56 ERIN ST, WHITMAN, MA 02382-2432
(508) 933-5013
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN89641
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LN89641
LPN
MA
Enumeration date
01/06/2019
Last updated
01/06/2019
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