Provider Demographics
NPI:1982212734
Name:WATTERS, PAMELLA SUE
Entity Type:Individual
Prefix:
First Name:PAMELLA
Middle Name:SUE
Last Name:WATTERS
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 1:533 AUGDON DR
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-3824
Mailing Address - Country:US
Mailing Address - Phone:440-406-4975
Mailing Address - Fax:
Practice Address - Street 1:533 AUGDON DR
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-3824
Practice Address - Country:US
Practice Address - Phone:440-406-4975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health