Provider Demographics
NPI:1326800707
Name:INGRAM, ZARATTA (LPN)
Entity Type:Individual
Prefix:
First Name:ZARATTA
Middle Name:
Last Name:INGRAM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 E BIRD AVE
Mailing Address - Street 2:
Mailing Address - City:WILMAR
Mailing Address - State:AR
Mailing Address - Zip Code:71675-8062
Mailing Address - Country:US
Mailing Address - Phone:870-776-0980
Mailing Address - Fax:
Practice Address - Street 1:324 E BIRD AVE
Practice Address - Street 2:
Practice Address - City:WILMAR
Practice Address - State:AR
Practice Address - Zip Code:71675-8062
Practice Address - Country:US
Practice Address - Phone:870-776-0980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant