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General NPI Number Information
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NPI Number | 1538511688
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Entity Type | Individual
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Provider Name | ALAN D WATERS
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Gender | Male
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Dates
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Enumeration Date | 07/12/2016
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Last Update Date | 04/11/2018
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Provider Practice Location Address
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Address Line | 957 BROOKHAVEN CT STE 3&4
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City | MUSKEGON
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State | MI
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Zip | 49442-3890
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Country | US
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Telephone | 231-777-1916
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Fax | 231-773-8904
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Provider Business Mailing Address
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Address Line | 470 OAKHURST AVE NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49504-4660
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Country | US
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Telephone | 616-453-3359
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704231084
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License Number State | MI
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