Individual
PHYLLIS ANNETTE INGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
750 N BROADWAY, PERU, IN 46970-1027
(260) 569-2120
(260) 569-2121
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71009335A
IN
363L00000X
Nurse Practitioner
CNP-03521
NM
363LF0000X
Family Nurse Practitioner
AP134764
TX
Other
Enumeration date
11/03/2017
Last updated
12/02/2025
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