MEDICARE: RACHEL ELIZABETH INGRAM FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024175240	VA

General Provider Information

NPI Number	:	1063931806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL ELIZABETH INGRAM FNP

Provider Business Mailing Address
First Line	:	5324 HILLSHIRE WAY
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-7145
Country	:	US
Telephone Number	:	804-687-1383
Fax Number	:	804-408-9399

Provider Business Practice Location Address
First Line	:	10431 PATTERSON AVE STE C24
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23238-5101
Country	:	US
Telephone Number	:	804-313-9109
Fax Number	:	804-408-9399

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2017
Last Update Date	:	03/03/2026

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