Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | CNP-03521 | NM |
N | 363LF0000X | Nurse Practitioner - Family Medicine | AP134764 | TX |
NPI | 1003328667 |
---|---|
Provider Name | Phyllis Annette Ingham |
First Address | Albuquerque, NM 87125-6666 |
Second Address | Albuquerque, NM 87106-5215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2017 |
Last Update Date | 17/04/2018 |