Provider Demographics
NPI:1386276442
Name:WATERBURY, MARIA (NP-C)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:WATERBURY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:CARRANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:261 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-8381
Mailing Address - Country:US
Mailing Address - Phone:203-668-3080
Mailing Address - Fax:
Practice Address - Street 1:261 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-8381
Practice Address - Country:US
Practice Address - Phone:203-668-3080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12824383-4405363LF0000X
FL11019242363LF0000X
CT9421363LF0000X, 363LP0808X
TXAP144602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily