Female

Miss Koran B. Watson

Registered Dietitian in Philadelphia, PA(View on Map)

Full Name

Miss Koran Bianca Watson

NPI Number

1174162572

NPI Type

Individual Provider

Gender

Female

Enumeration Date

01/02/2020

Specialties

(Taxonomies)

Code

133V00000X

Primary Taxonomy

Yes

Licenses

State

Pennsylvania
Pennsylvania

License Number

DN0006020
DN006020

Contact
Information

Purpose

Mailing
Location

Address

21 S 11TH ST
21 S 11TH ST

City

Philadelphia
Philadelphia

State

PA
PA

Postal Code

19107-4223
19107-4223

Country

US
US

Telephone Number

(267) 209-3245
(267) 209-3245

Identifiers

Identifier

DN006020

Identifier State

PA

Identifier Issuer

PA NURSING BROAD

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 08/12/2022

Provider Address

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