Provider Demographics
NPI:1407814056
Name:WATERS, SARAH MIMA
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:MIMA
Last Name:WATERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 BARSTOW RD
Mailing Address - Street 2:APT #14
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-4988
Mailing Address - Country:US
Mailing Address - Phone:781-710-3603
Mailing Address - Fax:
Practice Address - Street 1:1250 BARSTOW RD
Practice Address - Street 2:APT #14
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-4988
Practice Address - Country:US
Practice Address - Phone:781-710-3603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA262598163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical