Provider Demographics
NPI:1558926121
Name:WATSKE, AUSTINE L
Entity Type:Individual
Prefix:
First Name:AUSTINE
Middle Name:L
Last Name:WATSKE
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 1:3568 DODGE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-3222
Mailing Address - Country:US
Mailing Address - Phone:402-345-0791
Mailing Address - Fax:402-345-0938
Practice Address - Street 1:3568 DODGE ST STE 2
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-3222
Practice Address - Country:US
Practice Address - Phone:402-345-0791
Practice Address - Fax:402-345-0938
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty