Provider Demographics
NPI:1124757620
Name:WATERS, EMMA (PA-C)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:44 MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:RICHFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05476-1141
Mailing Address - Country:US
Mailing Address - Phone:802-299-1180
Mailing Address - Fax:
Practice Address - Street 1:1199 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VT
Practice Address - Zip Code:05454-9530
Practice Address - Country:US
Practice Address - Phone:802-849-2844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant