Healthcare Provider Details

I. General information

NPI: 1316855711
Provider Name (Legal Business Name): LVN WATERS HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 ORCHARD HARVEST DR
CHESTER VA
23836-7916
US

IV. Provider business mailing address

612 ORCHARD HARVEST DR
CHESTER VA
23836-7916
US

V. Phone/Fax

Practice location:
  • Phone: 804-446-4821
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ABISOLA CANADY
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 917-558-7986