Provider Demographics
NPI:1447411681
Name:INGRAM, LISA (MA)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:INGRAM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 BOYDEN AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2480
Mailing Address - Country:US
Mailing Address - Phone:973-378-6652
Mailing Address - Fax:973-378-6435
Practice Address - Street 1:180 BOYDEN AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2480
Practice Address - Country:US
Practice Address - Phone:973-378-6652
Practice Address - Fax:973-378-6435
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide