Provider Demographics
NPI:1336404086
Name:INGRAHAM, DEANNA J
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:J
Last Name:INGRAHAM
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 1:2311 LOWER MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:RANSOMVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14131-9723
Mailing Address - Country:US
Mailing Address - Phone:585-330-8243
Mailing Address - Fax:
Practice Address - Street 1:2311 LOWER MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:RANSOMVILLE
Practice Address - State:NY
Practice Address - Zip Code:14131-9723
Practice Address - Country:US
Practice Address - Phone:585-330-8243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY105361071OtherNYS TEACH