Individual
MS. MARY R. INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3200 CANYON LAKE DR, RAPID CITY, SD 57702-8114
(605) 355-2443
(605) 355-2403
Mailing address
3200 CANYON LAKE DR, RAPID CITY, SD 57702-8114
(605) 355-2443
(605) 355-2403
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RPO22257
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5549050
—
SD
Enumeration date
04/13/2006
Last updated
11/08/2011
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