Provider Demographics
NPI:1093127011
Name:WATERMAN, LINDSAY MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:MARIE
Last Name:WATERMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:M
Other - Last Name:KRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:419 S L ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-3799
Mailing Address - Country:US
Mailing Address - Phone:253-403-8410
Mailing Address - Fax:
Practice Address - Street 1:419 S L ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-3799
Practice Address - Country:US
Practice Address - Phone:253-403-8410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-26
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 60456893363LA2200X
WAAP60456893363L00000X, 363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1093127011Medicaid
WA8931323Medicare PIN