Provider Demographics
NPI:1295910925
Name:INGRAM, DEBRA LEE (LPN)
Entity type:Individual
Prefix:MISS
First Name:DEBRA
Middle Name:LEE
Last Name:INGRAM
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 1:4006 MONTICELLO BLVD APT 202
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1761
Mailing Address - Country:US
Mailing Address - Phone:330-330-5270
Mailing Address - Fax:
Practice Address - Street 1:4006 MONTICELLO BLVD APT 202
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1761
Practice Address - Country:US
Practice Address - Phone:330-330-5270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN072884164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse