Healthcare Provider Details

I. General information

NPI: 1689598666
Provider Name (Legal Business Name): CHRISTINE WATERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 W SPRINGER DR
TURLOCK CA
95382-7314
US

IV. Provider business mailing address

1005 FANTASY CT
TURLOCK CA
95382-8335
US

V. Phone/Fax

Practice location:
  • Phone: 350-206-3900
  • Fax:
Mailing address:
  • Phone: 350-206-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number646394
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: