Provider Demographics
NPI:1790223550
Name:WATERS, MONIQUE MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:MARIE
Last Name:WATERS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 OAKESDALE AVE SW STE 104
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5226
Mailing Address - Country:US
Mailing Address - Phone:866-951-0183
Mailing Address - Fax:
Practice Address - Street 1:600 OAKESDALE AVE SW STE 104
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5226
Practice Address - Country:US
Practice Address - Phone:866-951-0183
Practice Address - Fax:425-228-4540
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9317901363L00000X
FLARNP 9317901363LP2300X
WA61030812363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care