Provider Demographics
NPI:1568348522
Name:WATERS, LAVONNE ANIECE
Entity type:Individual
Prefix:MRS
First Name:LAVONNE
Middle Name:ANIECE
Last Name:WATERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4748 N 150TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-1454
Mailing Address - Country:US
Mailing Address - Phone:913-593-3877
Mailing Address - Fax:
Practice Address - Street 1:4748 N 150TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-1454
Practice Address - Country:US
Practice Address - Phone:913-593-3877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant