Individual
MICHAEL INGERSOLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8014
Mailing address
3302 56TH AVE UNIT 203, KENOSHA, WI 53144-4908
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
15311430
WI
Other
Enumeration date
05/25/2010
Last updated
08/28/2022
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