Provider Demographics
NPI:1487963914
Name:WATANABE, TOMOE (RN)
Entity type:Individual
Prefix:MS
First Name:TOMOE
Middle Name:
Last Name:WATANABE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2-13-25 SOBUDAI
Mailing Address - Street 2:
Mailing Address - City:SAGAMIHARA
Mailing Address - State:KANAGAWA
Mailing Address - Zip Code:2520324
Mailing Address - Country:JP
Mailing Address - Phone:0118146-407-4127
Mailing Address - Fax:
Practice Address - Street 1:2-13-25 SOBUDAI
Practice Address - Street 2:
Practice Address - City:SAGAMIHARA
Practice Address - State:KANAGAWA
Practice Address - Zip Code:2520324
Practice Address - Country:JP
Practice Address - Phone:0118146-407-4127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA652399163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
903250522OtherFOREIGN ID NUMBER