Individual
VESNA WATTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 765-8585
Mailing address
PO BOX 35145 #40023, SEATTLE, WA 98124-5145
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
28176058A
IN
367500000X
Certified Registered Nurse Anesthetist
589582
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA-952
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000788387
ANTHEM PROVIDER NUMBER
IN
05
—
201078810
—
IN
Enumeration date
01/03/2012
Last updated
08/24/2021
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