Ingram, Mary R.

Ingram, Mary R. is an individual health care provider with primary practice located at 3200 Canyon Lake Dr , Rapid City SD 57702-8114. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Ingram, Mary R. can be contacted via phone (605) 355-2443.

Contact Information

Primary practice address
3200 Canyon Lake Dr Rapid City SD 57702-8114
Phone: (605) 355-2443
Fax: (605) 355-2403
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X RPO22257 South Dakota

Profile Details

NPI number 1164486452
LBN Legal business name Ingram, Mary R.
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 13th, 2006
Last updated Nov 8th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164486452 NPPES
South Dakota MEDICAID 5549050

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