Healthcare Provider Details

I. General information

NPI: 1265623391
Provider Name (Legal Business Name): SHERYL ANNE INGRAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

118 CHEROKEE LN
NOBLESVILLE IN
46062-9073
US

IV. Provider business mailing address

118 CHEROKEE LN
NOBLESVILLE IN
46062-9073
US

V. Phone/Fax

Practice location:
  • Phone: 317-217-9389
  • Fax:
Mailing address:
  • Phone: 317-217-9389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28082461A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: