Healthcare Provider Details

I. General information

NPI: 1790805430
Provider Name (Legal Business Name): ERIN C INGRAM R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERIN C NEMEC R.N.

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 SUN VALLEY RD
CLARKSVILLE TN
37040-4371
US

IV. Provider business mailing address

1306 SUN VALLEY RD
CLARKSVILLE TN
37040-4371
US

V. Phone/Fax

Practice location:
  • Phone: 931-980-8012
  • Fax:
Mailing address:
  • Phone: 931-980-8012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number141198
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: