Provider Demographics
NPI:1376090183
Name:INGERSOL, HEIDI (RN)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:INGERSOL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 SARATOGA TRL
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-7157
Mailing Address - Country:US
Mailing Address - Phone:216-408-2793
Mailing Address - Fax:330-721-8916
Practice Address - Street 1:2500 E 22ND ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3204
Practice Address - Country:US
Practice Address - Phone:216-315-0628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH220222163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health