Provider Demographics
NPI:1538987730
Name:WATERS, REBECCA SUZANNE MARIE (PNP-PC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUZANNE MARIE
Last Name:WATERS
Suffix:
Gender:F
Credentials:PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 4TH ST N APT 136
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-3027
Mailing Address - Country:US
Mailing Address - Phone:808-343-2288
Mailing Address - Fax:
Practice Address - Street 1:3060 WILLIAMS DR STE 520
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4648
Practice Address - Country:US
Practice Address - Phone:703-289-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024191102363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics