Individual
DEITRA ANN WATSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1011 18TH ST N, 2B, FARGO, ND 58102-3238
(701) 212-9200
Mailing address
1011 18TH ST N, 2B, FARGO, ND 58102-3238
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
011245235
IL
225700000X
Massage Therapist
011245235
IL
Other
Enumeration date
09/24/2007
Last updated
12/20/2007
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