Individual
CARISSA WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
836 W WELLINGTON AVE, CHICAGO, IL 60657-5147
(773) 296-1295
Mailing address
541 W OAKDALE AVE APT 402, CHICAGO, IL 60657-5736
Taxonomy
Speciality
Code
Description
License number
State
364SA2100X
Acute Care Clinical Nurse Specialist
Primary
209015912
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209015912
APN LICENSE
IL
Enumeration date
05/15/2017
Last updated
05/15/2017
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