Individual
THEA WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1101 ATLANTIC AVE, ATLANTIC CITY, NJ 08401-4805
(609) 344-2700
Mailing address
24 FRAMBES AVE, PLEASANTVILLE, NJ 08232-3305
(609) 328-8484
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
26NP06310100
NJ
Other
Enumeration date
04/05/2023
Last updated
04/05/2023
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