Healthcare Provider Details

I. General information

NPI: 1588204622
Provider Name (Legal Business Name): JAMIE WATERS RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 E RICH ST
COLUMBUS OH
43215-5341
US

IV. Provider business mailing address

2945 COLLIER HILL CT
HILLIARD OH
43026-7285
US

V. Phone/Fax

Practice location:
  • Phone: 614-975-2265
  • Fax:
Mailing address:
  • Phone: 614-975-2265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-101180
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: