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General NPI Number Information
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NPI Number | 1467455808
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Entity Type | Individual
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Provider Name | LISA RENEE WATERMAN D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 5501 WILLOW CREEK DR STE 203
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City | SPRINGDALE
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State | AR
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Zip | 72762-8708
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Country | US
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Telephone | 479-757-5552
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Fax | 479-757-2942
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Provider Business Mailing Address
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Address Line | 5501 WILLOW CREEK DR STE 203
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City | SPRINGDALE
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State | AR
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Zip | 72762-8708
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Country | US
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Telephone | 405-413-4351
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Fax | 479-757-2942
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | E-18839
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License Number State | AR
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