Provider Demographics
NPI:1740029149
Name:INGRAM, LANEATRA DANYEL (LPN)
Entity type:Individual
Prefix:
First Name:LANEATRA
Middle Name:DANYEL
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 1:1202 CAMDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27260-3618
Mailing Address - Country:US
Mailing Address - Phone:336-803-9823
Mailing Address - Fax:
Practice Address - Street 1:1202 CAMDEN AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-3618
Practice Address - Country:US
Practice Address - Phone:336-803-9823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC91468164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse