MEDICARE: REBECCA S INGERSOLL NP-C

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	COA.17560-NP	OH

General Provider Information

NPI Number	:	1174906697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA S INGERSOLL NP-C

Provider Business Mailing Address
First Line	:	5888 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-2815
Country	:	US
Telephone Number	:	614-882-4343
Fax Number	:	614-882-4664

Provider Business Practice Location Address
First Line	:	5888 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-2815
Country	:	US
Telephone Number	:	614-882-4343
Fax Number	:	614-882-4664

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

Provider Enumeration Date	:	07/01/2015
Last Update Date	:	07/10/2015

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