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General NPI Number Information
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NPI Number | 1336743095
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Entity Type | Individual
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Provider Name | MARYROSE WATERS
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Gender | Female
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 300 COMMUNITY DR
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City | MANHASSET
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State | NY
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Zip | 11030-3876
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Country | US
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Telephone | 516-562-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 87 TARDY LN N
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City | WANTAGH
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State | NY
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Zip | 11793-1930
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Country | US
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Telephone | 516-473-3714
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Fax |
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | F431881-01
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License Number State | NY
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