Provider Demographics
NPI:1790805430
Name:INGRAM, ERIN C (RN)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:C
Last Name:INGRAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:C
Other - Last Name:NEMEC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1306 SUN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-4371
Mailing Address - Country:US
Mailing Address - Phone:931-980-8012
Mailing Address - Fax:
Practice Address - Street 1:1306 SUN VALLEY RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-4371
Practice Address - Country:US
Practice Address - Phone:931-980-8012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN141198163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse