Provider Demographics
NPI:1275300360
Name:INGRAM, TANEJA DARION
Entity Type:Individual
Prefix:
First Name:TANEJA
Middle Name:DARION
Last Name:INGRAM
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 1:3527 ALBANY KNOLL LN APT G
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-6254
Mailing Address - Country:US
Mailing Address - Phone:614-816-1159
Mailing Address - Fax:
Practice Address - Street 1:3527 ALBANY KNOLL LN APT G
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-6254
Practice Address - Country:US
Practice Address - Phone:614-816-1159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide