Provider Demographics
NPI:1598462376
Name:INGRAM, KALANI LAURA (SA-C)
Entity Type:Individual
Prefix:
First Name:KALANI
Middle Name:LAURA
Last Name:INGRAM
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6474 E PLACITA MADERA ANTIGUA
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-9184
Mailing Address - Country:US
Mailing Address - Phone:520-539-4008
Mailing Address - Fax:
Practice Address - Street 1:6474 E PLACITA MADERA ANTIGUA
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-9184
Practice Address - Country:US
Practice Address - Phone:520-539-4008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23-120246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant