Individual
NICKI GOSSAGE INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS, CLC, LCCE, IBCLC
Contact information
Practice address
1920 SOUTHVIEW AVE, BARTLESVILLE, OK 74003-6234
(918) 578-9036
Mailing address
1920 SOUTHVIEW AVE, BARTLESVILLE, OK 74003-6234
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
—
—
174N00000X
Lactation Consultant (Non-RN)
Primary
—
—
374J00000X
Doula
—
—
Other
Enumeration date
01/09/2018
Last updated
01/09/2018
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