Individual
ANNE INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
910 NW 16TH STREET, STE 101, FRUITLAND, ID 83619
(208) 452-8000
(208) 452-8055
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 452-8000
(208) 452-8055
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1031
ID
Other
Enumeration date
03/28/2013
Last updated
11/09/2016
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