Provider Demographics
NPI:1881312700
Name:WATERS, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 N WOODMERE FAIRWAY UNIT 2005
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-1766
Mailing Address - Country:US
Mailing Address - Phone:480-560-5951
Mailing Address - Fax:
Practice Address - Street 1:4909 N WOODMERE FAIRWAY UNIT 2005
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-1766
Practice Address - Country:US
Practice Address - Phone:480-560-5951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach