Provider Demographics
NPI:1043334238
Name:HEMINGWAY, INGRID KELLY
Entity Type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:KELLY
Last Name:HEMINGWAY
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 1:3030 ALUM ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-2807
Mailing Address - Country:US
Mailing Address - Phone:408-254-3396
Mailing Address - Fax:408-254-2383
Practice Address - Street 1:3030 ALUM ROCK AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-2807
Practice Address - Country:US
Practice Address - Phone:408-254-3396
Practice Address - Fax:408-254-2383
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator