Provider Demographics
NPI:1235259383
Name:WATERS, ARYONNA BELLA (LMP / LMT)
Entity Type:Individual
Prefix:MRS
First Name:ARYONNA
Middle Name:BELLA
Last Name:WATERS
Suffix:
Gender:F
Credentials:LMP / LMT
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 591
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:WA
Mailing Address - Zip Code:98610-0591
Mailing Address - Country:US
Mailing Address - Phone:509-427-7797
Mailing Address - Fax:509-427-7797
Practice Address - Street 1:100 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:WA
Practice Address - Zip Code:98648-4225
Practice Address - Country:US
Practice Address - Phone:509-427-7797
Practice Address - Fax:509-427-7797
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15880172V00000X
WAMA00023703225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist