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General NPI Number Information
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NPI Number | 1184725301
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Entity Type | Individual
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Provider Name | DEBORAH MAURI VAN DER WATT CRNP
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Gender | Female
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | WALTER REED ARMY MEDICAL CTR 6900 GEORGIA AVENUE NW
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City | WASHINGTON
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State | DC
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Zip | 20307-0001
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Country | US
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Telephone | 202-782-1181
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Fax |
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Provider Business Mailing Address
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Address Line | 9320 CEDAR LN
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City | BETHESDA
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State | MD
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Zip | 20814-3935
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Country | US
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Telephone | 301-564-0469
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Fax | 610-661-3406
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP007298
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License Number State | PA
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