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General NPI Number Information
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NPI Number | 1639047053
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Entity Type | Individual
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Provider Name | ILSA CHRISTINE WATERMAN AGPCNP
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Gender | Female
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Dates
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Enumeration Date | 10/27/2025
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 750 WARNER DR
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City | GOLDEN
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State | CO
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Zip | 80401-5297
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Country | US
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Telephone | 303-925-4380
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Fax |
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Provider Business Mailing Address
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Address Line | 2578 S NORSE CT
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City | LAKEWOOD
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State | CO
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Zip | 80228-6475
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Country | US
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Telephone | 573-337-4077
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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 | APN.1001312-NP
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License Number State | CO
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