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General NPI Number Information
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NPI Number | 1023813607
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Entity Type | Individual
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Provider Name | CHANELL C. WATERS NP
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Gender | Female
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 229 N MAIN ST STE 207
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City | SMYRNA
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State | DE
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Zip | 19977-1192
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Country | US
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Telephone | 302-378-8358
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Fax | 302-883-8395
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Provider Business Mailing Address
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Address Line | 229 N MAIN ST STE 207
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City | SMYRNA
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State | DE
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Zip | 19977-1192
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Country | US
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Telephone | 302-378-8358
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Fax | 302-883-8395
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | L8-0010734
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License Number State | DE
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