Healthcare Provider Details

I. General information

NPI: 1801316740
Provider Name (Legal Business Name): TERRY WATERS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 04/26/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 LETRADO ST
SANTA FE NM
87505-4146
US

IV. Provider business mailing address

10 AVENIDA DE MOLINO
ESPANOLA NM
87532-9865
US

V. Phone/Fax

Practice location:
  • Phone: 505-476-2600
  • Fax:
Mailing address:
  • Phone: 505-927-7912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03263
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: