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Contact Information

NICOLE P WATERS, DO, PHD
7211 US 45 S
CARRIER MILLS, IL62917-1305
 Phone: 618-294-8247
 Fax: 618-294-8247
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for NICOLE P WATERS · (Female)

NPI # 1407416308
Status Active
Credentials DO, PHD
Entity Individual
Enumeration date 06/13/2019
Last updated 02/06/2026 - About 4 months ago
Sole proprietor 1 No
Identifiers
  • IL License # 036157809
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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