Provider Demographics
NPI:1487496139
Name:INGRAM, NANCY SHARON (LMBT)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:SHARON
Last Name:INGRAM
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 IDEAL WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5625
Mailing Address - Country:US
Mailing Address - Phone:704-523-8841
Mailing Address - Fax:704-523-8841
Practice Address - Street 1:676 IDEAL WAY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5625
Practice Address - Country:US
Practice Address - Phone:704-523-8841
Practice Address - Fax:704-523-8841
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC170225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty