MEDICARE: CHRISTINE DIANE WATERS-CLAYTON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F331545-1	NY

General Provider Information

NPI Number	:	1174649149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE DIANE WATERS-CLAYTON FNP

Provider Business Mailing Address
First Line	:	53 CAMPEAU PL
Second Line	:
City	:	BERGENFIELD
State	:	NJ
Zip	:	07621-3324
Country	:	US
Telephone Number	:	201-387-1728
Fax Number	:

Provider Business Practice Location Address
First Line	:	163 W 125TH ST
Second Line	:	4TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10027-4436
Country	:	US
Telephone Number	:	212-531-8001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	06/28/2026

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