Healthcare Provider Details

I. General information

NPI: 1104980671
Provider Name (Legal Business Name): CHRISTINE FRANCES INGRAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E HOUSTON AVE
GILBERT AZ
85234-3427
US

IV. Provider business mailing address

431 E MEADOWS LN
GILBERT AZ
85234-2445
US

V. Phone/Fax

Practice location:
  • Phone: 480-497-9790
  • Fax: 480-813-6997
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN046360
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: