Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 0024171899 | VA |
NPI | 1043629090 |
---|---|
Provider Name | Mrs. Devin Alfano Waters |
First Address | Baltimore, MD 21297-3215 |
Second Address | Washington, DC 20010-2916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2014 |
Last Update Date | 16/06/2015 |