Provider Demographics
NPI:1689886590
Name:PACK, AMIEE D
Entity Type:Individual
Prefix:
First Name:AMIEE
Middle Name:D
Last Name:PACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6784 STATE ROUTE 141
Mailing Address - Street 2:
Mailing Address - City:KITTS HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45645
Mailing Address - Country:US
Mailing Address - Phone:740-534-9441
Mailing Address - Fax:740-643-0164
Practice Address - Street 1:6784 STATE ROUTE 141
Practice Address - Street 2:
Practice Address - City:KITTS HILL
Practice Address - State:OH
Practice Address - Zip Code:45645
Practice Address - Country:US
Practice Address - Phone:740-534-9441
Practice Address - Fax:740-643-0164
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide