Provider Demographics
NPI:1760875637
Name:INGRAO, DESTINEE ROSE
Entity Type:Individual
Prefix:
First Name:DESTINEE
Middle Name:ROSE
Last Name:INGRAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3758 BUREL MILL DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-1975
Mailing Address - Country:US
Mailing Address - Phone:678-200-4832
Mailing Address - Fax:
Practice Address - Street 1:3758 BUREL MILL DR
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-1975
Practice Address - Country:US
Practice Address - Phone:678-200-4832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program