Provider Demographics
NPI:1073922191
Name:WATERS, LEOLA DANEILLE
Entity Type:Individual
Prefix:
First Name:LEOLA
Middle Name:DANEILLE
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 1:494 S NAPOLEON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2259
Mailing Address - Country:US
Mailing Address - Phone:330-957-1066
Mailing Address - Fax:
Practice Address - Street 1:494 S NAPOLEON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2259
Practice Address - Country:US
Practice Address - Phone:330-957-1066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion