Healthcare Provider Details

I. General information

NPI: 1548474497
Provider Name (Legal Business Name): JANET INGRAM MARCUS APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 CONNECTICUT AVE NW SUITE 401
WASHINGTON DC
20036-1111
US

IV. Provider business mailing address

4300 OLD DOMINION DR #615
ARLINGTON VA
22207-3246
US

V. Phone/Fax

Practice location:
  • Phone: 703-314-6189
  • Fax: 202-444-6697
Mailing address:
  • Phone: 703-314-6189
  • Fax: 202-444-6697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN965787
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: