Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | SC005782 | PA |
NPI | 1063513588 |
---|---|
Provider Name | Dr. Dana Harris Waters |
First Address | Drexel Hill, PA 19026-3805 |
Second Address | Drexel Hill, PA 19026-3805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 11/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V12090 | (02) | NJ |