Provider Demographics
NPI:1134562531
Name:INGRAM, JOANNE (NURSE)
Entity type:Individual
Prefix:MISS
First Name:JOANNE
Middle Name:
Last Name:INGRAM
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3313
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44309
Mailing Address - Country:US
Mailing Address - Phone:234-788-6729
Mailing Address - Fax:
Practice Address - Street 1:300 N. SPRINGHILL DR.
Practice Address - Street 2:
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056
Practice Address - Country:US
Practice Address - Phone:330-908-1718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN091555164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse