Provider Demographics
NPI:1134172695
Name:WEINKLE, ELLA S (APR)
Entity type:Individual
Prefix:MRS
First Name:ELLA
Middle Name:S
Last Name:WEINKLE
Suffix:
Gender:F
Credentials:APR
Other - Prefix:MISS
Other - First Name:ELLA
Other - Middle Name:S
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APR
Mailing Address - Street 1:15 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-8003
Mailing Address - Country:US
Mailing Address - Phone:803-255-3417
Mailing Address - Fax:803-255-3451
Practice Address - Street 1:THOMSON STUDENT HEALTH CENTER 1400 GREENE STREET
Practice Address - Street 2:ROOM 303
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29208-0001
Practice Address - Country:US
Practice Address - Phone:803-777-5373
Practice Address - Fax:803-255-3451
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR92602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0740Medicaid
SCNP0740Medicaid
Q01456Medicare UPIN