Provider Demographics
NPI:1205354610
Name:PACK, CAROLINE SUSAN
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:SUSAN
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 1:2260 CRICKET CT. S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-3657
Mailing Address - Country:US
Mailing Address - Phone:707-999-8793
Mailing Address - Fax:
Practice Address - Street 1:2260 CRICKET CT. S
Practice Address - Street 2:
Practice Address - City:SALEW
Practice Address - State:OR
Practice Address - Zip Code:97302-3657
Practice Address - Country:US
Practice Address - Phone:707-999-8793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist