Provider Demographics
NPI:1295779221
Name:INGRAM, YVETTE M (PHD, LAT, ATC)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:M
Last Name:INGRAM
Suffix:
Gender:F
Credentials:PHD, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 WILLIS HEALTH PROFESSIONS BUILDING
Mailing Address - Street 2:LOCK HAVEN UNIVERSITY
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-1212
Mailing Address - Country:US
Mailing Address - Phone:570-660-0738
Mailing Address - Fax:
Practice Address - Street 1:115 WILLIS HEALTH PROFESSIONS BUILDING
Practice Address - Street 2:LOCK HAVEN UNIVERSITY
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-1212
Practice Address - Country:US
Practice Address - Phone:570-660-0738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001325A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer