Provider Demographics
NPI:1225361041
Name:WATERS, CYNTHIA LOUISE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:WATERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:LOUISE
Other - Last Name:LUTSKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:100 BREWSTER BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28547-2575
Mailing Address - Country:US
Mailing Address - Phone:910-450-2603
Mailing Address - Fax:910-450-3762
Practice Address - Street 1:100 BREWSTER BLVD
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547-2575
Practice Address - Country:US
Practice Address - Phone:910-450-4799
Practice Address - Fax:910-450-4452
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9297402363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health