=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164970695
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA E INGS ACNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2016
-----------------------------------------------------
Last Update Date | 09/23/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 WARREN AVE SUITE 401
-----------------------------------------------------
City | EAST PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02914-1430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-508-4908
-----------------------------------------------------
Fax | 401-228-6236
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 DAVOL SQ SUITE 400
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02903-4754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-421-4000
-----------------------------------------------------
Fax | 401-272-1456
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | APRN 01455
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------