Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP60456893 | WA |
N | 363LA2200X | Nurse Practitioner - Adult Health | AP 60456893 | WA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP60456893 | WA |
NPI | 1093127011 |
---|---|
Provider Name | Lindsay Marie Waterman |
First Address | Tacoma, WA 98405-3799 |
Second Address | Tacoma, WA 98405-3799 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2014 |
Last Update Date | 02/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093127011 | (05) | WA |