Provider Demographics
NPI:1770052862
Name:INGERSOL, BRENA LEE (NP)
Entity type:Individual
Prefix:
First Name:BRENA
Middle Name:LEE
Last Name:INGERSOL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13345 ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3318
Mailing Address - Country:US
Mailing Address - Phone:317-396-1300
Mailing Address - Fax:317-352-3417
Practice Address - Street 1:120 AVON MARKET PL STE 100
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6021
Practice Address - Country:US
Practice Address - Phone:317-396-1300
Practice Address - Fax:317-396-1395
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71008687A363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN363LF0000XOtherTAXONOMY