Healthcare Provider Details

I. General information

NPI: 1336133099
Provider Name (Legal Business Name): TRACY LEA INGRAM F.N.P., R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY LEA RUBLE F.N.P.R.N.

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 N LINCOLN ST
GREENSBURG IN
47240-1348
US

IV. Provider business mailing address

3306 N COUNTY ROAD 420 W
GREENSBURG IN
47240-7793
US

V. Phone/Fax

Practice location:
  • Phone: 812-662-0588
  • Fax: 812-663-5932
Mailing address:
  • Phone: 812-663-7596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71001970A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71001970A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: