Provider Demographics
NPI:1053647404
Name:INGWERSON, ROBERT LEE (LPN)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEE
Last Name:INGWERSON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 NW WILSON ST.
Mailing Address - Street 2:ATTN: ICU
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503-9042
Mailing Address - Country:US
Mailing Address - Phone:580-558-2600
Mailing Address - Fax:
Practice Address - Street 1:BLDG. 4300 MOW-WAY RD.
Practice Address - Street 2:ATTN: ICU
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73503-9042
Practice Address - Country:US
Practice Address - Phone:580-558-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0045276164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse