Watters, Geoffrey B

Watters, Geoffrey B is an individual health care provider with primary practice located at 1220 Dewey Ave , Wauwatosa WI 53213-2504. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is his primary health care specialty. Watters, Geoffrey B can be contacted via phone (414) 454-6753.

Contact Information

Primary practice address
1220 Dewey Ave Wauwatosa WI 53213-2504
Phone: (414) 454-6753
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 10388-33 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 10388-33 Wisconsin

Profile Details

NPI number 1407464118
LBN Legal business name Watters, Geoffrey B
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 20th, 2020
Last updated Oct 16th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407464118 NPPES
Wisconsin MEDICAID 100105234
Wisconsin MEDICAID 100105470

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