Provider Demographics
NPI:1619029865
Name:PACKARD, STEPHANIE T (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:T
Last Name:PACKARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:T
Other - Last Name:SINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 NORTH DUKE ST.
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602
Mailing Address - Country:US
Mailing Address - Phone:717-544-4978
Mailing Address - Fax:717-544-7043
Practice Address - Street 1:555 NORTH DUKE ST.
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602
Practice Address - Country:US
Practice Address - Phone:717-544-4978
Practice Address - Fax:717-544-7043
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC02760363A00000X
PAMA055322363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00138853OtherRAILROAD MED
PA2682762OtherHIGHMARK BLUE SHIELD-FREEDOM BLUE
PA1604209OtherGATEWAY MEDICARE ASSURED
PA2682762OtherHIGHMARK BLUE SHIELD-FREEDOM BLUE
MD761LH369Medicare PIN
PA232375FLTMedicare PIN