Individual
GEOFFREY B WATTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1220 DEWEY AVE, WAUWATOSA, WI 53213-2504
(414) 454-6753
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(414) 773-4312
(414) 454-6789
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
10388-33
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
10388-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100105234
—
WI
05
—
100105470
—
WI
Enumeration date
07/20/2020
Last updated
10/16/2023
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