Healthcare Provider Details

I. General information

NPI: 1932151693
Provider Name (Legal Business Name): LINDA H INGRAM APRN,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8340 BANDFORD WAY SUITE 101
RALEIGH NC
27615-2755
US

IV. Provider business mailing address

8340 BANDFORD WAY SUITE 101
RALEIGH NC
27615-2755
US

V. Phone/Fax

Practice location:
  • Phone: 919-870-0568
  • Fax: 919-848-6048
Mailing address:
  • Phone: 919-870-0568
  • Fax: 919-848-6048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number039130
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: