Individual
JORDAN SCOTT INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-3202
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-3202
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
317615
NC
367500000X
Certified Registered Nurse Anesthetist
138463
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
6702
NC
Other
Enumeration date
06/22/2021
Last updated
12/01/2021
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