Individual
TAMMY WATZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 PROGRESS PKWY, SULLIVAN, MO 63080-2359
(573) 468-3555
Mailing address
101 PROGRESS PKWY, SULLIVAN, MO 63080-2359
(573) 468-3555
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN089912
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
423846807
—
MO
01
—
P01135474
RAILROAD MEDICARE
MO
Enumeration date
08/31/2006
Last updated
08/19/2014
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