Individual
EVELINE GRACE WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
132 14TH ST, FOND DU LAC, WI 54935-5804
(920) 266-2882
Mailing address
132 14TH ST, FOND DU LAC, WI 54935-5804
(920) 266-2882
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
230434-30
WI
Other
Enumeration date
02/13/2023
Last updated
02/13/2023
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