Provider Demographics
NPI:1801483755
Name:INGMAN, HANNAH GRACE
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:GRACE
Last Name:INGMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3961 115TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-9201
Mailing Address - Country:US
Mailing Address - Phone:701-590-9197
Mailing Address - Fax:
Practice Address - Street 1:675 9TH ST E
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-6207
Practice Address - Country:US
Practice Address - Phone:701-483-1471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-27
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDING-93-5550172A00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No172A00000XOther Service ProvidersDriver