Individual
MRS. ROLANDA WATSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1900 W POLK ST, CHICAGO, IL 60612-3723
(312) 864-7569
(312) 864-9009
Mailing address
PO BOX 334, LANSING, IL 60438-0334
(708) 418-3645
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
041249746
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417195876
—
IL
05
—
1821305434
—
IL
Enumeration date
10/16/2018
Last updated
10/16/2018
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