Provider Demographics
NPI:1851081574
Name:WATERS, CHIOMA WINIFRED
Entity Type:Individual
Prefix:
First Name:CHIOMA
Middle Name:WINIFRED
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 1:132 CHIEF JUSTICE CUSHING HWY STE 70
Mailing Address - Street 2:
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025-1259
Mailing Address - Country:US
Mailing Address - Phone:781-469-1013
Mailing Address - Fax:781-469-1013
Practice Address - Street 1:132 CHIEF JUSTICE CUSHING HWY STE 70
Practice Address - Street 2:
Practice Address - City:COHASSET
Practice Address - State:MA
Practice Address - Zip Code:02025
Practice Address - Country:US
Practice Address - Phone:781-469-1013
Practice Address - Fax:781-469-1013
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRN2357815363LP0808X
MARN2357815363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health