Individual
DEBRA KAY WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MLT
Contact information
Practice address
BLACK COAL RD. BLDG. 29, FT. WASHAKIE, WY 82514
(307) 332-7672
Mailing address
29 BLACK COAL RD., FT. WASHAKIE, WY 82514
(307) 332-7672
Taxonomy
Speciality
Code
Description
License number
State
246RM2200X
Medical Laboratory Technician
Primary
21259
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04121413
ASCP
TN
Enumeration date
04/16/2010
Last updated
04/16/2010
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