Provider Demographics
NPI:1548069404
Name:INGRAM, DEBORAH LYNN
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:INGRAM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CARTER RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1053
Mailing Address - Country:US
Mailing Address - Phone:315-781-0404
Mailing Address - Fax:315-828-1791
Practice Address - Street 1:101 CARTER RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1053
Practice Address - Country:US
Practice Address - Phone:315-781-0404
Practice Address - Fax:315-828-1791
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY703829163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse