1841668399 NPI number — JOANNA WATERHOUSE RN, CDE, CPT

Table of content: JOANNA WATERHOUSE RN, CDE, CPT (NPI 1841668399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841668399 NPI number — JOANNA WATERHOUSE RN, CDE, CPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATERHOUSE
Provider First Name:
JOANNA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, CDE, CPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841668399
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
493 BLACKWELL RD
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
WARRENTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20186-2639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-347-4400
Provider Business Mailing Address Fax Number:
540-341-8610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
493 BLACKWELL RD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
WARRENTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20186-2639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-347-4400
Provider Business Practice Location Address Fax Number:
540-341-8610
Provider Enumeration Date:
09/14/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  20410019 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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