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NPI Code Detail

MEDICARE: MRS. LAURA MICHELLE INGRUM NP-C

MEDICARE: MRS. LAURA MICHELLE INGRUM 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
1363L00000XNurse PractitionerNP500011974DC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
171001999AOTHERINNP LICENSE

General Provider Information

NPI Number : 1295726859
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURA MICHELLE INGRUM NP-C
Provider Business Mailing Address
First Line : M/MED/QI, SA-1
Second Line : US DEPARTMENT OF STATE
City : WASHINGTON
State : DC
Zip : 20522-0102
Country : US
Telephone Number : 202-663-1519
Fax Number : 260-496-8077
Provider Business Practice Location Address
First Line : M/MED/QI, SA-1
Second Line : US DEPARTMENT OF STATE
City : WASHINGTON
State : DC
Zip : 20522-0102
Country : US
Telephone Number : 202-663-1519
Fax Number : 260-496-8077
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 09/04/2025

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