Provider Demographics
NPI:1093525602
Name:INGRAM, MARILYN J
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:J
Last Name:INGRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 FM 2100 RD APT 4104
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-5696
Mailing Address - Country:US
Mailing Address - Phone:346-383-4789
Mailing Address - Fax:
Practice Address - Street 1:5925 FM 2100 RD APT 4104
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:TX
Practice Address - Zip Code:77532-5696
Practice Address - Country:US
Practice Address - Phone:346-383-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider