Provider Demographics
NPI:1073755237
Name:WATERS, ROSEMARIE (LMP)
Entity Type:Individual
Prefix:MISS
First Name:ROSEMARIE
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 748
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-0748
Mailing Address - Country:US
Mailing Address - Phone:719-650-5541
Mailing Address - Fax:
Practice Address - Street 1:315 S. KOBUK ST.
Practice Address - Street 2:SUITE #2
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669
Practice Address - Country:US
Practice Address - Phone:907-420-0820
Practice Address - Fax:253-639-4809
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60055196172V00000X
AK101540225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172V00000XOther Service ProvidersCommunity Health Worker