Provider Demographics
NPI:1730477845
Name:WATERS, MELISSA KATHERINE (RN)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:KATHERINE
Last Name:WATERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 MID PINES CT APT 2D
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3165
Mailing Address - Country:US
Mailing Address - Phone:410-218-2198
Mailing Address - Fax:
Practice Address - Street 1:214 MID PINES CT APT 2D
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3165
Practice Address - Country:US
Practice Address - Phone:410-218-2198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR134899163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse