Provider Demographics
NPI:1275509630
Name:WATERS, MARGARET M (NP)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:M
Last Name:WATERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:63 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:PA
Practice Address - Zip Code:16933-1501
Practice Address - Country:US
Practice Address - Phone:570-662-7766
Practice Address - Fax:570-662-0348
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP003379B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02657165Medicaid
PACC9269OtherRR MEDICARE GROUP
PAP00319068OtherRR MEDICARE PIN
PAGU040009OtherPA MEDCIARE GROUP
PACC9269OtherRR MEDICARE GROUP
PA035577N9XMedicare PIN