Provider Demographics
NPI:1710770508
Name:WATERS, LEOCELL A (BSN,RN)
Entity type:Individual
Prefix:MRS
First Name:LEOCELL
Middle Name:A
Last Name:WATERS
Suffix:
Gender:F
Credentials:BSN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27265 PACHEA TRL
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-8118
Mailing Address - Country:US
Mailing Address - Phone:951-742-3994
Mailing Address - Fax:
Practice Address - Street 1:624 E ELDER ST
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3004
Practice Address - Country:US
Practice Address - Phone:760-451-4165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95418685163W00000X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse