Healthcare Provider Details

I. General information

NPI: 1780659938
Provider Name (Legal Business Name): JANICE INGHAM L.P.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 STATE ROUTE 220
PIKETON OH
45661-9722
US

IV. Provider business mailing address

248 STATE ROUTE 220
PIKETON OH
45661-9722
US

V. Phone/Fax

Practice location:
  • Phone: 740-493-3217
  • Fax: 740-493-3217
Mailing address:
  • Phone: 740-493-3217
  • Fax: 740-493-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN068585
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: