Provider Demographics
NPI:1366833048
Name:INGRAM, RACHEL DIANE (RN, BSN, RNC-OB)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:DIANE
Last Name:INGRAM
Suffix:
Gender:F
Credentials:RN, BSN, RNC-OB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 827 BOX 473
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09617-0005
Mailing Address - Country:US
Mailing Address - Phone:39342-087-9979
Mailing Address - Fax:
Practice Address - Street 1:PSC 827 BOX 473
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09617-0005
Practice Address - Country:US
Practice Address - Phone:39342-087-9979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO189906163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient