Eveline Grace Waters

Primary specialty

Addiction (Substance Use Disorder) Registered NurseTaxonomy code 163WA0400X

License

230434-30 Issued in WI

Practice address

132 14TH St
Fond Du Lac, WI 54935-5804

Phone

(920) 266-2882

NPI assigned

Feb 13, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1676246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676246400000",
    "number": "1346947181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 14TH ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549355804",
            "telephone_number": "920-266-2882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 14TH ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549355804",
            "telephone_number": "920-266-2882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "EVELINE",
        "middle_name": "GRACE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-13",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "230434-30",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacob Robert Wallock, DDS
• Katherine Kristine Waltenberry
• Jeffrey L Walters, D.C.
• Hong Chu Wang, M.D.
• Margaret L Ward
• Renee Louise Waters, CMT
• Tanya Watry, PA-C
• Conor Watson
• Waupun Memorial Hospital
• Chad W Way

• Addiction (Substance Use Disorder) Registered Nurse in Fond Du Lac, WI
• Providers in Fond Du Lac, WI by specialty
• Addiction (Substance Use Disorder) Registered Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.