Provider Demographics
NPI:1295042950
Name:WATERHOUSE, SHIRLEY ANN (RN, ANP-C)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:ANN
Last Name:WATERHOUSE
Suffix:
Gender:F
Credentials:RN, ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8443 FORGET ME NOT ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-8666
Mailing Address - Country:US
Mailing Address - Phone:440-541-8076
Mailing Address - Fax:
Practice Address - Street 1:1950 W 3RD ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-1812
Practice Address - Country:US
Practice Address - Phone:928-366-1091
Practice Address - Fax:928-276-4481
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12242-NP363LA2200X
AZAP10160363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP10160OtherSTATE MEDICAL LICENSE
AZ276777Medicaid