Provider Demographics
NPI:1801068655
Name:INGHRAM, FLOREENE T (RN)
Entity type:Individual
Prefix:MRS
First Name:FLOREENE
Middle Name:T
Last Name:INGHRAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6451 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4109
Mailing Address - Country:US
Mailing Address - Phone:440-255-6609
Mailing Address - Fax:440-255-6609
Practice Address - Street 1:7090 HOPKINS RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4487
Practice Address - Country:US
Practice Address - Phone:440-255-6609
Practice Address - Fax:440-255-6609
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN262321163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2709126Medicaid