Provider Demographics
NPI:1740249804
Name:WATERS-DECKER, PATRICIA ANNE (APRN, CNM)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANNE
Last Name:WATERS-DECKER
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANNE
Other - Last Name:WATERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, CNM
Mailing Address - Street 1:9260 W. SUNSET RD.
Mailing Address - Street 2:STE. 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4903
Mailing Address - Country:US
Mailing Address - Phone:702-255-3547
Mailing Address - Fax:702-921-2419
Practice Address - Street 1:10105 BANBURRY CROSS
Practice Address - Street 2:STE. 460
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144
Practice Address - Country:US
Practice Address - Phone:702-255-3547
Practice Address - Fax:702-255-3549
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN 00446367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002402048Medicaid
NV002402048Medicaid