Basic Information
| Provider Information | |||||||||
| NPI: | 1548540503 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | INGRAM | ||||||||
| FirstName: | ANNIE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | STEPHENS | ||||||||
| OtherFirstName: | ANNIE | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 100 ROUSE DR | ||||||||
| Address2: | |||||||||
| City: | AVONDALE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193111379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108830105 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 252 CHAPMAN RD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197025436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3023661929 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2011 | ||||||||
| LastUpdateDate: | 08/23/2011 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | L10032644 | DE | N | Nursing Service Providers | Registered Nurse | 363LA2200X | LB0000253 | DE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.