Provider Demographics
NPI:1073217352
Name:WATERS, DANEDA MARIE
Entity Type:Individual
Prefix:
First Name:DANEDA
Middle Name:MARIE
Last Name:WATERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956 CLIFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-2757
Mailing Address - Country:US
Mailing Address - Phone:330-803-5653
Mailing Address - Fax:
Practice Address - Street 1:956 CLIFFORD AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-2757
Practice Address - Country:US
Practice Address - Phone:330-803-5653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-05-18
Deactivation Date:2023-04-18
Deactivation Code:
Reactivation Date:2023-05-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide