Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 18713 | HI |
N | 2080P0210X | Pediatric Nephrologist | 35-088687 | OH |
NPI | 1841445921 |
---|---|
Provider Name | Dr. Susan Elizabeth Ingraham |
First Address | Honolulu, HI 96814-1956 |
Second Address | Honolulu, HI 96814-1956 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2008 |
Last Update Date | 21/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3147866 | (05) | OH |