Provider Demographics
NPI:1588209563
Name:INGRAM, ROSALYN A (APRN)
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:A
Last Name:INGRAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 NEWELL RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-5100
Mailing Address - Country:US
Mailing Address - Phone:860-583-9252
Mailing Address - Fax:860-585-9848
Practice Address - Street 1:25 NEWELL RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5100
Practice Address - Country:US
Practice Address - Phone:860-583-9252
Practice Address - Fax:860-585-9848
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8622363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health