Provider Demographics
NPI:1548540503
Name:INGRAM, ANNIE ELIZABETH (NP-C)
Entity type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:ELIZABETH
Last Name:INGRAM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:ELIZABETH
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 ROUSE DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19311-1379
Mailing Address - Country:US
Mailing Address - Phone:610-883-0105
Mailing Address - Fax:
Practice Address - Street 1:252 CHAPMAN RD
Practice Address - Street 2:SUITE 150
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5436
Practice Address - Country:US
Practice Address - Phone:302-366-1929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL10032644163W00000X
DELB0000253363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse