Individual
INGRAM JANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
501 S POPLAR ST, ELIZABETHTOWN, NC 28337-9375
(910) 862-5100
(910) 862-1238
Mailing address
PO BOX 398, ELIZABETHTOWN, NC 28337-0398
(910) 862-5100
(910) 862-1238
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
101948
NC
Other
Enumeration date
11/29/2006
Last updated
07/09/2007
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