Provider Demographics
NPI:1699047605
Name:INGRAM, KATHERINE BROOKS (CRNA)
Entity type:Individual
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First Name:KATHERINE
Middle Name:BROOKS
Last Name:INGRAM
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Gender:F
Credentials:CRNA
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Mailing Address - Street 1:1720 LOUISIANA BLVD NE
Mailing Address - Street 2:SUITE #401
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7022
Mailing Address - Country:US
Mailing Address - Phone:505-260-4300
Mailing Address - Fax:505-260-4371
Practice Address - Street 1:2014 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1607
Practice Address - Country:US
Practice Address - Phone:617-243-6298
Practice Address - Fax:505-841-1956
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2022-10-24
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Provider Licenses
StateLicense IDTaxonomies
TNRN0000169920367500000X
NMCRNA -367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered