Most Relevant Information
Provider Data
| NPI Number: | 1003823022 |
| Provider Name: | ANGELA ELLISE WATSON PAC |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | PA00394 |
Most Important Dates
| Enumeration Date: | 08/02/2006 |
| Last Updated: | 09/28/2022 |
Provider Practice Location
2400 HARTMAN LN
SPRINGFIELD
OR
974771118
Practice Location Phone/Fax
| Phone: | 5413343350 |
| Fax: | 5412845198 |
Provider Mailing Location
2400 HARTMAN LN
SPRINGFIELD
OR
974771118
Provider Mailing Phone/Fax
| Phone: | 5413343350 |
| Fax: | 5412845198 |