Individual
JOHNALICE WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
275 BECK AVE, FAIRFIELD, CA 94533-6804
(707) 784-6660
Mailing address
275 BECK AVE, FAIRFIELD, CA 94533-6804
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
769637
CA
Other
Enumeration date
12/07/2015
Last updated
12/07/2015
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