Provider Demographics
NPI:1841668399
Name:WATERHOUSE, JOANNA (RN, CDE, CPT)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:WATERHOUSE
Suffix:
Gender:F
Credentials:RN, CDE, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 BLACKWELL RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2639
Mailing Address - Country:US
Mailing Address - Phone:540-347-4400
Mailing Address - Fax:540-341-8610
Practice Address - Street 1:493 BLACKWELL RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2639
Practice Address - Country:US
Practice Address - Phone:540-347-4400
Practice Address - Fax:540-341-8610
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA20410019133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered