Provider Demographics
NPI:1023813607
Name:WATERS, CHANELL C (NP)
Entity type:Individual
Prefix:
First Name:CHANELL
Middle Name:C
Last Name:WATERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 N MAIN ST STE 207
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-1192
Mailing Address - Country:US
Mailing Address - Phone:302-378-8358
Mailing Address - Fax:302-883-8395
Practice Address - Street 1:229 N MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1192
Practice Address - Country:US
Practice Address - Phone:302-378-8358
Practice Address - Fax:302-883-8395
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL8-0010734363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health