| Doctor Name: | MS. NICOLE GAY INGRAM |
| NPI Number: | 1154392223 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 200550147 |
| Business Practice Address: | 19250 Sw 65th Ave Ste 300 Tualatin, OR - 970627707 |
| Business Phone Number: | 5038551205 |
| Business Fax Number: | |
| Mailing Address: | 19250 Sw 65th Ave Ste 300, TUALATIN |
| State: | OR |
| Postal Code: | 970627707 |
| Phone Number: | 5038551205 |
| Fax Number: | |
| NPI Enumeration Date: | 01/27/2006 |
| NPI Last Update Date: | 10/15/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 200550147 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |