Healthcare Provider Details

I. General information

NPI: 1134172695
Provider Name (Legal Business Name): ELLA S WEINKLE A.P.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: ELLA S LYNCH A.P.R.

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THOMSON STUDENT HEALTH CENTER 1400 GREENE STREET ROOM 303
COLUMBIA SC
29208-0001
US

IV. Provider business mailing address

15 MEDICAL PARK RD SUITE 300
COLUMBIA SC
29203-8003
US

V. Phone/Fax

Practice location:
  • Phone: 803-777-5373
  • Fax: 803-255-3451
Mailing address:
  • Phone: 803-255-3417
  • Fax: 803-255-3451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR92602
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: