Provider Demographics
NPI:1447970314
Name:INGRAM, ANGELIQUE RENEE (RN)
Entity type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:RENEE
Last Name:INGRAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:WHEATLEY HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11798-1226
Mailing Address - Country:US
Mailing Address - Phone:914-672-5123
Mailing Address - Fax:
Practice Address - Street 1:85 WILLOW ST
Practice Address - Street 2:
Practice Address - City:WHEATLEY HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11798-1226
Practice Address - Country:US
Practice Address - Phone:914-672-5123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY600469163WA0400X, 163WP0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WP0000XNursing Service ProvidersRegistered NursePain Management