Provider Demographics
NPI:1780623330
Name:INGRAM, JUDY M (CRNP)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:M
Last Name:INGRAM
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Gender:F
Credentials:CRNP
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Mailing Address - Street 1:5055 E BROADWAY BLVD
Mailing Address - Street 2:SUITE A-100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3640
Mailing Address - Country:US
Mailing Address - Phone:520-327-0460
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:6565 E CARONDELET DR STE 175
Practice Address - Street 2:ASSOCIATES IN FAMILY PRACTICE
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-3526
Practice Address - Country:US
Practice Address - Phone:520-547-5960
Practice Address - Fax:520-547-5969
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2009-05-08
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Provider Licenses
StateLicense IDTaxonomies
AZ047003363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S48020Medicare ID - Type Unspecified