Provider Demographics
NPI:1881070126
Name:PACK, JANICE LEE
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:LEE
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 1:8234 HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:WETUMKA
Mailing Address - State:OK
Mailing Address - Zip Code:74883-9529
Mailing Address - Country:US
Mailing Address - Phone:405-786-2203
Mailing Address - Fax:405-786-2625
Practice Address - Street 1:8234 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:WETUMKA
Practice Address - State:OK
Practice Address - Zip Code:74883-9529
Practice Address - Country:US
Practice Address - Phone:405-786-2203
Practice Address - Fax:405-786-2625
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care