MEDICARE: ANGELA INGRAM

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1083022099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA INGRAM

Provider Business Mailing Address
First Line	:	9200 WORTHINGTON RD FL 3
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43082-8823
Country	:	US
Telephone Number	:	612-642-7796
Fax Number	:

Provider Business Practice Location Address
First Line	:	9200 WORTHINGTON RD FL 3
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43082-8823
Country	:	US
Telephone Number	:	612-642-7796
Fax Number	:

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

Provider Enumeration Date	:	07/23/2014
Last Update Date	:	07/23/2014

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Directions to “ ANGELA INGRAM ” Practice Location

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