Provider Demographics
NPI:1174262711
Name:WATERS, CHERYL DENISE
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:DENISE
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:PO BOX 1310
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43552-1310
Mailing Address - Country:US
Mailing Address - Phone:419-244-5348
Mailing Address - Fax:888-228-7479
Practice Address - Street 1:10893 SUN TRACE DR
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-6413
Practice Address - Country:US
Practice Address - Phone:419-244-5348
Practice Address - Fax:888-228-7479
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty