Provider Demographics
NPI:1821183005
Name:INGIMUNDSON, TAWNYA J (CNP)
Entity Type:Individual
Prefix:
First Name:TAWNYA
Middle Name:J
Last Name:INGIMUNDSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6621 GULTON CT NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4407
Mailing Address - Country:US
Mailing Address - Phone:505-888-0443
Mailing Address - Fax:505-888-1398
Practice Address - Street 1:6621 GULTON CT NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4407
Practice Address - Country:US
Practice Address - Phone:505-888-0443
Practice Address - Fax:505-888-1398
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR41588207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000B9556Medicaid
P23405Medicare UPIN
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