MEDICARE: MR. RICHARD W ATER ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN00112428	WA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP30005332	WA

General Provider Information

NPI Number	:	1285669234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD W ATER ARNP

Provider Business Mailing Address
First Line	:	12345 LAKE CITY WAY NE STE 117
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-5401
Country	:	US
Telephone Number	:	206-335-2892
Fax Number	:	206-629-7660

Provider Business Practice Location Address
First Line	:	12345 LAKE CITY WAY NE STE 117
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-5401
Country	:	US
Telephone Number	:	206-335-2892
Fax Number	:	206-629-7660

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	11/19/2024

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