Healthcare Provider Details

I. General information

NPI: 1730366386
Provider Name (Legal Business Name): BRANDY E. INGRAM P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 S MILL AVE STE D12 D12
TEMPE AZ
85282-6849
US

IV. Provider business mailing address

5030 S MILL AVE STE D12
TEMPE AZ
85282-6849
US

V. Phone/Fax

Practice location:
  • Phone: 480-894-2823
  • Fax: 480-756-6663
Mailing address:
  • Phone: 480-894-2823
  • Fax: 480-756-6663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3713
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: