Provider Demographics
NPI:1932712494
Name:PACK, ELIZABETH JOLENE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JOLENE
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 1:784 COUNTY ROAD 411 APT 502
Mailing Address - Street 2:
Mailing Address - City:PROCTORVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45669-7004
Mailing Address - Country:US
Mailing Address - Phone:304-896-2371
Mailing Address - Fax:
Practice Address - Street 1:784 COUNTY ROAD 411 APT 502
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-7004
Practice Address - Country:US
Practice Address - Phone:304-896-2371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant