Provider Demographics
NPI:1497495097
Name:MCWATERS, NATALIE JOYCE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:JOYCE
Last Name:MCWATERS
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 1:38976 COUNTY 1 BLVD
Mailing Address - Street 2:
Mailing Address - City:DENNISON
Mailing Address - State:MN
Mailing Address - Zip Code:55018-5406
Mailing Address - Country:US
Mailing Address - Phone:507-251-3671
Mailing Address - Fax:
Practice Address - Street 1:427 WEST TRAVELERS TRAIL
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55377
Practice Address - Country:US
Practice Address - Phone:952-247-2954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician