1710095484 NPI number — MRS. ELIZABETH A PACKHEM RN LCDCS CD

Table of content: MRS. ELIZABETH A PACKHEM RN LCDCS CD (NPI 1710095484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710095484 NPI number — MRS. ELIZABETH A PACKHEM RN LCDCS CD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PACKHEM
Provider First Name:
ELIZABETH
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN LCDCS CD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCHALE
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710095484
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
166 VINEYARD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02889
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-737-7941
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 MINNESOTA AVE
Provider Second Line Business Practice Location Address:
THE KENT CENTER
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02888
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-738-0685
Provider Business Practice Location Address Fax Number:
401-738-4413
Provider Enumeration Date:
08/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  LCDCS 00014 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 163W00000X , with the licence number: RN08467 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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