Individual
LISA M. WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1506 W REYNOLDS ST, PONTIAC, IL 61764
(815) 844-6123
(815) 844-7851
Mailing address
1506 W REYNOLDS ST, PONTIAC, IL 61764
(815) 844-6123
(815) 844-7851
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
041217560/209002332
IL
Other
Enumeration date
10/01/2006
Last updated
02/28/2011
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