Provider Demographics
NPI:1457115552
Name:INGRAM, TASHAI
Entity Type:Individual
Prefix:
First Name:TASHAI
Middle Name:
Last Name:INGRAM
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:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:WILBERFORCE
Mailing Address - State:OH
Mailing Address - Zip Code:45384-0056
Mailing Address - Country:US
Mailing Address - Phone:937-789-5848
Mailing Address - Fax:
Practice Address - Street 1:1394 GARCIA DR
Practice Address - Street 2:
Practice Address - City:WILBERFORCE
Practice Address - State:OH
Practice Address - Zip Code:45384
Practice Address - Country:US
Practice Address - Phone:937-789-5848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker