Provider Demographics
NPI:1518559566
Name:INGRAM, MARY BROOKS (RN, LAC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BROOKS
Last Name:INGRAM
Suffix:
Gender:F
Credentials:RN, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 BEGGS RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-3328
Mailing Address - Country:US
Mailing Address - Phone:410-905-9659
Mailing Address - Fax:
Practice Address - Street 1:1259 BEGGS RD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-3328
Practice Address - Country:US
Practice Address - Phone:410-905-9659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR200895163W00000X
MDU02794171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAK001410OtherPENNSYLVANIA BOARD OF MEDICINE
MDR200895OtherMARYLAND BOARD OF NURSING
MDU02794OtherMARYLAND BOARD OF ACUPUNCTURE