Provider Demographics
NPI:1225173313
Name:INGRAM, CINDY LEE (CRNA)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:LEE
Last Name:INGRAM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:LEE
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:272 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9031
Mailing Address - Country:US
Mailing Address - Phone:740-779-7540
Mailing Address - Fax:740-779-7867
Practice Address - Street 1:100 DAWN LN
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-9138
Practice Address - Country:US
Practice Address - Phone:740-947-6391
Practice Address - Fax:740-947-6538
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNA-08616367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2465943Medicaid
OH311072406Other3RD PARTY PAYERS