Provider Demographics
NPI:1982009338
Name:WATERS, JOAN DELYSE (ND)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:DELYSE
Last Name:WATERS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 271496
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80527-1496
Mailing Address - Country:US
Mailing Address - Phone:970-482-2010
Mailing Address - Fax:888-835-3244
Practice Address - Street 1:3950 JFK PKWY
Practice Address - Street 2:#2
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3073
Practice Address - Country:US
Practice Address - Phone:970-482-2010
Practice Address - Fax:888-835-3244
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COND.0000083175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath