Active NPI
Christina L Watters, M.S, R.D.
- Registered Dietitian
- Rock Island, IL
National Provider Identifier
1558602979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164.004912
- Practice address
- 2930 18TH Ave
Rock Island, IL 61201-4757 - Phone
- (309) 793-0684
- NPI assigned
- Mar 11, 2013
- Last updated
- Mar 11, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164.004912 | IL | Primary |
| Registered Dietitian | 133V00000X | 001981 | IA |
Addresses
Primary practice location
2930 18TH Ave
Rock Island, IL 61201-4757
Mailing address
2930 18TH Ave
Rock Island, IL 61201-4757
Phone (309) 793-0684
Other names 1
- Miss Christina L Mitzel
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001981 | IA | MD | Registered Dietitian |
| 164.004912 | IL | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hy-Vee Inc | Past | Accepting new patients | |
| Hy-Vee Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1362960000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362960000000",
"number": "1558602979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2930 18TH AVE",
"city": "ROCK ISLAND",
"state": "IL",
"postal_code": "612014757",
"telephone_number": "309-793-0684"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2930 18TH AVE",
"city": "ROCK ISLAND",
"state": "IL",
"postal_code": "612014757",
"telephone_number": "309-793-0684"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATTERS",
"first_name": "CHRISTINA",
"middle_name": "L",
"name_prefix": "Mrs.",
"credential": "M.S, R.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-03-11",
"last_updated": "2013-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164.004912",
"primary": true
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IA",
"license": "001981",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "CHRISTINA",
"last_name": "MITZEL",
"middle_name": "L",
"prefix": "MISS",
"credential": "M.S, R.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Rock Island, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.