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NPI Code Detail

MEDICARE: OLIVIA ANGELIQUE INGRAM

MEDICARE: OLIVIA ANGELIQUE INGRAM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner0041974OH

General Provider Information

NPI Number : 1740118355
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLIVIA ANGELIQUE INGRAM
Provider Business Mailing Address
First Line : PO BOX 11167
Second Line :
City : FORT WAYNE
State : IN
Zip : 46856-1167
Country : US
Telephone Number : 574-546-1900
Fax Number : 574-546-1999
Provider Business Practice Location Address
First Line : 21 E STATE ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43215-4281
Country : US
Telephone Number : 574-546-1900
Fax Number : 574-546-1999
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2026
Last Update Date : 05/12/2026

Similar Medicare Providers

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1932749843 — MS. JULIE M MCCLAIN FNP-BC
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1831185545 — JAMES B SHACKSON M.D.
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Directions to “ OLIVIA ANGELIQUE INGRAM ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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