Provider Demographics
NPI:1205636255
Name:WATERS, ELIZABETH RUTH
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RUTH
Last Name:WATERS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1953 WELSENBORO CIR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3343
Mailing Address - Country:US
Mailing Address - Phone:865-437-7762
Mailing Address - Fax:
Practice Address - Street 1:2200 CHILDREN'S WAY DOT 10 GASTROENTEROLOGY
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0001
Practice Address - Country:US
Practice Address - Phone:865-437-7762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN210523163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse