Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | D-5311 | ID |
Y | 213EG0000X | General Practice | D-5311 | ID |
NPI | 1003487802 |
---|---|
Provider Name | Dr. Hannah Marie Ingram |
First Address | Hillsboro, OR 97124-5611 |
Second Address | Coeur D Alene, ID 83814-4904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2021 |
Last Update Date | 02/07/2021 |