Individual
CAROL MARY PACKARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
221 E 10TH ST, OGALLALA, NE 69153-1425
(308) 284-8421
Mailing address
PO BOX 26, OGALLALA, NE 69153-0026
(308) 284-8421
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
459
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47-083450613
—
NE
Enumeration date
03/14/2006
Last updated
07/15/2010
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