Individual
AMANDA CHRISTINE PACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1044 BELMONT AVE, YOUNGSTOWN, OH 44504-1006
(330) 480-3658
(330) 480-3439
Mailing address
4135 BOARDMAN CANFIELD RD STE 101, CANFIELD, OH 44406-9803
(330) 286-5330
(330) 286-5396
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN.CRNA.17032
OH
367500000X
Certified Registered Nurse Anesthetist
RN342265COA1
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000912918
ANTHEM BCBS
OH
05
—
0117817
—
OH
01
—
13547104
CAQH
—
01
—
H435190
MEDICARE PTAN
OH
01
—
P02076614
MEDICARE RAILROAD PTAN
OH
Enumeration date
01/29/2015
Last updated
02/08/2021
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