Provider Demographics
NPI:1275242737
Name:WATERS, JAMES ROBERT (DNP, MPH, RN, CPH)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:WATERS
Suffix:
Gender:M
Credentials:DNP, MPH, RN, CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 704 BOX 1312
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96338-0014
Mailing Address - Country:US
Mailing Address - Phone:702-677-4113
Mailing Address - Fax:
Practice Address - Street 1:UNIT 45011
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96343-5011
Practice Address - Country:US
Practice Address - Phone:315-263-5889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1634518163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health