Healthcare Provider Details

I. General information

NPI: 1871065458
Provider Name (Legal Business Name): STEPHANIE ANN INGRAM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 EAST 17TH STREET 10 BAIRD HALL
NEW YORK NY
10003
US

IV. Provider business mailing address

350 EAST 17TH STREET 10 BAIRD HALL
NEW YORK NY
10003
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-4155
  • Fax: 212-420-4048
Mailing address:
  • Phone: 212-420-4155
  • Fax: 212-420-4048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number343726
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00943300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: