Provider Demographics
NPI:1780659938
Name:INGHAM, JANICE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:
Last Name:INGHAM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 STATE ROUTE 220
Mailing Address - Street 2:
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661-9722
Mailing Address - Country:US
Mailing Address - Phone:740-493-3217
Mailing Address - Fax:740-493-3217
Practice Address - Street 1:248 STATE ROUTE 220
Practice Address - Street 2:
Practice Address - City:PIKETON
Practice Address - State:OH
Practice Address - Zip Code:45661-9722
Practice Address - Country:US
Practice Address - Phone:740-493-3217
Practice Address - Fax:740-493-3217
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN068585164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2132776Medicaid