Individual
MS. GAY GUNDERSEN WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN FNP
Contact information
Practice address
7900 W JEFFERSON BLVD STE 304, FORT WAYNE, IN 46804-4128
(260) 969-6200
(260) 969-6201
Mailing address
PO BOX 8857, FORT WAYNE, IN 46898-8857
(260) 969-6200
(260) 969-6201
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
28161069A
IN
363LF0000X
Family Nurse Practitioner
Primary
71004003A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000780053
ANTHEM
IN
05
—
201092300
—
IN
Enumeration date
06/12/2012
Last updated
08/13/2013
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