Provider Demographics
NPI:1477316586
Name:INGRAM, ANTOINETTE (RN)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:INGRAM
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 1:781 WATERSIDE DR APT 103
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-4512
Mailing Address - Country:US
Mailing Address - Phone:864-680-4919
Mailing Address - Fax:
Practice Address - Street 1:661 RUTHERFORD RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-4640
Practice Address - Country:US
Practice Address - Phone:864-232-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC221437163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty