Individual
KENDYL INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSFA
Contact information
Practice address
2101 W 32ND ST, PUEBLO, CO 81008-1321
(719) 231-0177
Mailing address
2101 W 32ND ST, PUEBLO, CO 81008-1321
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
SA.0002224
CO
Other
Enumeration date
06/12/2017
Last updated
06/21/2017
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