Individual
MS. CAROLYN C WATTERWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1141 N MONROE DR, XENIA, OH 45385
(937) 372-8011
(937) 376-6983
Mailing address
PO BOX 951568, CLEVELAND, OH 44193
(937) 293-0247
(937) 293-0960
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN161162
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000381924
ANTHEM
OH
05
—
0806980
—
OH
01
—
P00281504
RAILROAD MEDICARE
OH
Enumeration date
01/30/2006
Last updated
07/08/2007
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