Provider Demographics
NPI:1841326188
Name:WATERS, PATRICIA SUE
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:SUE
Last Name:WATERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 HARPER STREET
Mailing Address - Street 2:
Mailing Address - City:NELSONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45764-1592
Mailing Address - Country:US
Mailing Address - Phone:740-753-3100
Mailing Address - Fax:
Practice Address - Street 1:50 SOUTH HIGH STREET
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-1060
Practice Address - Country:US
Practice Address - Phone:740-385-5864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2421347OtherWAIVER