Provider Demographics
NPI:1639608938
Name:WATZKA, INGRID (RN)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:WATZKA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:
Other - Last Name:ESTRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1911 SATURN LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-2940
Mailing Address - Country:US
Mailing Address - Phone:845-652-0634
Mailing Address - Fax:
Practice Address - Street 1:2715 COLONIAL DR # 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6818
Practice Address - Country:US
Practice Address - Phone:803-898-1555
Practice Address - Fax:803-898-4830
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC239534163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse