Provider Demographics
NPI:1033856695
Name:WATERS, RACHEL (MSN, RN, PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:MSN, RN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2212
Mailing Address - Country:US
Mailing Address - Phone:915-204-2579
Mailing Address - Fax:
Practice Address - Street 1:84 BROAD ST STE 2
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4381
Practice Address - Country:US
Practice Address - Phone:518-636-5284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY404177363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health