Provider Demographics
NPI:1912366550
Name:WAUTERS, THERESE M (RN)
Entity Type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:M
Last Name:WAUTERS
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 1:24364 GIVENS CIR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-6851
Mailing Address - Country:US
Mailing Address - Phone:302-663-0934
Mailing Address - Fax:
Practice Address - Street 1:24364 GIVENS CIR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-6851
Practice Address - Country:US
Practice Address - Phone:302-663-0934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0047536163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care