Provider Demographics
NPI:1558101865
Name:INGRAM, LINDSEY IRENE
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:IRENE
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 1:13016 BELLE MEADE LN
Mailing Address - Street 2:
Mailing Address - City:MARKHAM
Mailing Address - State:VA
Mailing Address - Zip Code:22643-1726
Mailing Address - Country:US
Mailing Address - Phone:217-929-8841
Mailing Address - Fax:
Practice Address - Street 1:120 N COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-2660
Practice Address - Country:US
Practice Address - Phone:540-635-0760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024190545363LW0102X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health