Provider Demographics
NPI:1043065261
Name:WATSON, VIRGINIA (PA-C)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 W CENTRAL RD STE 7200
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2382
Mailing Address - Country:US
Mailing Address - Phone:847-618-4430
Mailing Address - Fax:847-618-0786
Practice Address - Street 1:880 W CENTRAL RD STE 7200
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2382
Practice Address - Country:US
Practice Address - Phone:847-618-4430
Practice Address - Fax:847-618-0786
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL085010572363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program