Most Relevant Information
Provider Data
| NPI Number: | 1003328667 |
| Provider Name: | PHYLLIS ANNETTE INGHAM NP-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | AP134764 |
Most Important Dates
| Enumeration Date: | 11/03/2017 |
| Last Updated: | 04/17/2018 |
Provider Practice Location
1100 LEAD AVE SE
ALBUQUERQUE
NM
871065215
Practice Location Phone/Fax
| Phone: | 5052247000 |
| Fax: |
Provider Mailing Location
PO BOX 26666
PHS PROVIDER ENROLLMENT
ALBUQUERQUE
NM
871256666
Provider Mailing Phone/Fax
| Phone: | 5059236770 |
| Fax: | 5059235354 |