Individual
MRS. BEVERLY ANN WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN PRIMARY PEDIATR, ERIE AVENUE AT FRONT STREET, PHILADELPHIA, PA 19134
(215) 427-5936
(215) 427-6501
Mailing address
1526 WYNSAM ST, PHILADELPHIA, PA 19138-1628
(215) 424-7033
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
VP001807D
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01469539
—
PA
Enumeration date
02/13/2007
Last updated
07/08/2007
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