Individual
MARY JO WATTERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
2511 OLD CORNWALLIS RD STE 200, DURHAM, NC 27713-1869
(919) 932-5700
Mailing address
411 W 18TH ST, LUMBERTON, NC 28358-4514
(910) 258-9467
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5012779
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14612409
—
NC
Enumeration date
01/29/2020
Last updated
02/10/2020
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