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General NPI Number Information
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NPI Number | 1558184234
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Entity Type | Organization
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Legal Business Name | TRACY INGRAM LLC
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Dates
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Enumeration Date | 11/01/2024
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 98-1247 KAAHUMANU ST STE 106
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City | AIEA
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State | HI
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Zip | 96701-5310
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Country | US
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Telephone | 808-583-6411
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Fax | 808-480-7589
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Provider Business Mailing Address
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Address Line | 98-1247 KAAHUMANU ST STE 106
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City | AIEA
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State | HI
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Zip | 96701-5310
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Country | US
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Telephone | 808-583-6411
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Fax | 808-480-7589
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Authorized Official
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Title or Position | OWNER
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Name | DR. TRACY LARGADO INGRAM
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Credential | DNP, APRN, PMHNP-BC
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Telephone | 808-583-6411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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