Individual
MICHAEL WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7248 ELMWOOD AVE, PHILADELPHIA, PA 19142-1533
(215) 416-2846
Mailing address
7248 ELMWOOD AVE, PHILADELPHIA, PA 19142-1533
(215) 416-2846
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN309237
PA
Other
Enumeration date
12/27/2018
Last updated
12/27/2018
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