Provider Demographics
NPI:1063615656
Name:INGRAM, PENNY (RNC, NP)
Entity type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:
Last Name:INGRAM
Suffix:
Gender:F
Credentials:RNC, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 CHURCHILL CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6127
Mailing Address - Country:US
Mailing Address - Phone:530-559-3442
Mailing Address - Fax:
Practice Address - Street 1:209 E SWALLOW RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2539
Practice Address - Country:US
Practice Address - Phone:970-223-7425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-09
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN0992568-NP364SW0102X
TX248762364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health