Provider Demographics
NPI:1649728056
Name:PACK, ALINE FAY (RN)
Entity type:Individual
Prefix:MRS
First Name:ALINE
Middle Name:FAY
Last Name:PACK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7438 DUNBAR
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-1430
Mailing Address - Country:US
Mailing Address - Phone:419-344-6195
Mailing Address - Fax:
Practice Address - Street 1:7438 DUNBAR AVE
Practice Address - Street 2:
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-1430
Practice Address - Country:US
Practice Address - Phone:419-344-6195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN246714163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse