Individual
DERRICK WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
444 HENRIETTA AVE, LOGAN, OH 43138-1634
(740) 677-3152
Mailing address
97 GROVER ST, NELSONVILLE, OH 45764-1076
(740) 677-3152
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
10/21/2022
Last updated
10/21/2022
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