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General NPI Number Information
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NPI Number | 1386025880
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Entity Type | Individual
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Provider Name | TERESA INGRAM
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Gender | Female
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 05/26/2020
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Provider Practice Location Address
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Address Line | 700 E TOWNSHIP LINE RD
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City | HAVERTOWN
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State | PA
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Zip | 19083-5733
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Country | US
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Telephone | 888-985-2727
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Fax |
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Provider Business Mailing Address
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Address Line | 1930 CHESTNUT ST 4E
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City | PHILADELPHIA
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State | PA
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Zip | 19103-4522
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Country | US
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Telephone | 610-613-3784
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP014998
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License Number State | PA
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