MEDICARE: LISA WATERS

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	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1881312700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA WATERS

Provider Business Mailing Address
First Line	:	4909 N WOODMERE FAIRWAY UNIT 2005
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-1766
Country	:	US
Telephone Number	:	480-560-5951
Fax Number	:

Provider Business Practice Location Address
First Line	:	4909 N WOODMERE FAIRWAY UNIT 2005
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-1766
Country	:	US
Telephone Number	:	480-560-5951
Fax Number	:

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

Provider Enumeration Date	:	08/16/2022
Last Update Date	:	08/16/2022

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Directions to “ LISA WATERS ” Practice Location

Language	Start Address	Practice Location

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