Individual
MS. TIFFANI ELLIS-INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6484 ROSS ST, PHILADELPHIA, PA 19119-2333
(267) 269-4248
Mailing address
6484 ROSS ST, PHILADELPHIA, PA 19119-2333
(267) 269-4248
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
02/03/2016
Last updated
02/03/2016
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