Individual
NINA MARIE WATERCOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1313 PENN AVE N, MINNEAPOLIS, MN 55411-3047
(612) 543-2500
Mailing address
4023 14TH AVE S APT 14A, MINNEAPOLIS, MN 55407-3261
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3320
MN
Other
Enumeration date
07/10/2012
Last updated
09/29/2020
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