Individual ProviderGay Gundersen WatsonNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address7900 W Jefferson Blvd Ste 304, Fort Wayne, IN 46804-4128(260) 969-6200PECOS EnrollmentBased on the most recent information from CMS, provider Gay Gundersen Watson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1164784518Provider TypeIndividualFull NameGundersen Watson, GayTitleMs.CredentialRN FNPGenderFemaleSole ProprietorNoEnumeration Date6/12/2012Last Updated8/13/2013Contact InformationPractice LocationPractice Address7900 W Jefferson Blvd Ste 304, Fort Wayne, IN 46804-4128Phone(260) 969-6200Fax(260) 969-6201Mailing LocationMailing AddressPO Box 8857, Fort Wayne, IN 46898-8857Phone(260) 969-6200Fax(260) 969-6201Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense71004003AIndianaCode363L00000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense28161069AIndianaProvider IdentifiersIDDescriptionIssuerID201092300DescriptionMedicaidIssuerUnlistedIndianaID000000780053DescriptionOtherIssuerANTHEMIndiana