Provider Demographics
NPI:1700020609
Name:PACK, ALISON REBECCA (MS RD LDN)
Entity Type:Individual
Prefix:MS
First Name:ALISON
Middle Name:REBECCA
Last Name:PACK
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6903 KILRAIN CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5328
Mailing Address - Country:US
Mailing Address - Phone:410-660-2328
Mailing Address - Fax:410-660-2329
Practice Address - Street 1:6903 KILRAIN CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5328
Practice Address - Country:US
Practice Address - Phone:410-660-2328
Practice Address - Fax:410-660-2329
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2732133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered