Carissa Waters, APN

Primary specialty

Acute Care Clinical Nurse SpecialistTaxonomy code 364SA2100X

License

209015912 Issued in IL

Practice address

836 W Wellington Ave
Chicago, IL 60657-5147

Phone

(773) 296-1295

NPI assigned

May 15, 2017

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

Other identifiers 1

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": "1494806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494806400000",
    "number": "1700313202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 W OAKDALE AVE APT 402",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606575736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "836 W WELLINGTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606575147",
            "telephone_number": "773-296-1295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "CARISSA",
        "credential": "APN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-15",
        "last_updated": "2017-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SA2100X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Acute Care",
            "state": "IL",
            "license": "209015912",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APN LICENSE",
            "identifier": "209015912",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Waterford Medical LTD
• Waterford Nursing & Rehabilitation Center Inc
• Waterfront Terrace, Inc.
• Helen Gerseny Waterman, D.O.
• Nadia Waterman, LPC
• David Michael Waters, M.D.
• Nicole Waters
• Patrick William Waters, PHARM.D.
• Tashauna Waters
• Theresa Latisha Waters

• Acute Care Clinical Nurse Specialist in Chicago, IL
• Providers in Chicago, IL by specialty
• Acute Care Clinical Nurse Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2017; 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.