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General NPI Number Information
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NPI Number | 1992041453
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Entity Type | Individual
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Provider Name | ALICIA JEAN WATERS MSN, BSN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/02/2013
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Last Update Date | 04/24/2024
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Provider Practice Location Address
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Address Line | 6455 MACHINE ST FL 3
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City | ABERDEEN PROVING GROUND
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State | MD
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Zip | 21005-5213
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Country | US
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Telephone | 410-278-1195
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Fax | 419-278-1766
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Provider Business Mailing Address
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Address Line | 425 GRASMERE DR
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City | ABERDEEN
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State | MD
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Zip | 21001-1834
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Country | US
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Telephone | 412-608-2428
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP10737
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP010737
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License Number State | PA
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