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General NPI Number Information
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NPI Number | 1962384107
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Entity Type | Individual
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Provider Name | STEPHANIE WATZKE RN
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Gender | Female
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 1520 W HARRISON ST
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City | CHICAGO
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State | IL
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Zip | 60607-3106
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Country | US
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Telephone | 312-563-9613
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Fax |
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Provider Business Mailing Address
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Address Line | 20 N ABERDEEN ST APT 305
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City | CHICAGO
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State | IL
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Zip | 60607-3042
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Country | US
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Telephone | 608-279-8206
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WX0200X
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Taxonomy Name | Oncology Registered Nurse
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License Number | 041464525
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License Number State | IL
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