Healthcare Provider Details

I. General information

NPI: 1477470615
Provider Name (Legal Business Name): DESTINY MARIE WATERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 9TH ST
PAWNEE CITY NE
68420-3607
US

IV. Provider business mailing address

718 9TH ST
PAWNEE CITY NE
68420-3607
US

V. Phone/Fax

Practice location:
  • Phone: 402-251-7120
  • Fax:
Mailing address:
  • Phone: 402-251-7120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: