Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | NV |
NPI | 1003241944 |
---|---|
Provider Name | Angel Patrice Ingram |
First Address | Las Vegas, NV 89115-2591 |
Second Address | Las Vegas, NV 89115-2591 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2013 |
Last Update Date | 11/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050504466-02 | UNITED HEALTHCARE (01) | NV |