Provider Demographics
NPI:1033792106
Name:PACK, SNANOBIA (CPD,LMP,MEDICAL LMA)
Entity Type:Individual
Prefix:
First Name:SNANOBIA
Middle Name:
Last Name:PACK
Suffix:
Gender:F
Credentials:CPD,LMP,MEDICAL LMA
Other - Prefix:
Other - First Name:SNANOBIA
Other - Middle Name:
Other - Last Name:PACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1346 PARK PL APT C6
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-2906
Mailing Address - Country:US
Mailing Address - Phone:347-909-1186
Mailing Address - Fax:
Practice Address - Street 1:1346 PARK PL APT C6
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-2906
Practice Address - Country:US
Practice Address - Phone:347-909-1186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN