Provider Demographics
NPI:1689619488
Name:WATERHOUSE, DIANE L (NP)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:L
Last Name:WATERHOUSE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:601 CHILDRENS LN
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1971
Mailing Address - Country:US
Mailing Address - Phone:757-668-7000
Mailing Address - Fax:757-668-9691
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1971
Practice Address - Country:US
Practice Address - Phone:757-668-9222
Practice Address - Fax:757-668-7568
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024115462363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007785828Medicaid
S85355Medicare UPIN
VA007785828Medicaid