Healthcare Provider Details

I. General information

NPI: 1225173313
Provider Name (Legal Business Name): CINDY LEE INGRAM C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CINDY LEE INGRAM CRNA

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DAWN LN
WAVERLY OH
45690-9138
US

IV. Provider business mailing address

272 HOSPITAL RD
CHILLICOTHEE OH
45601-9031
US

V. Phone/Fax

Practice location:
  • Phone: 740-947-6391
  • Fax: 740-947-6538
Mailing address:
  • Phone: 740-779-7540
  • Fax: 740-779-7867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA-08616
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: