Individual
TIARA F PACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
0614
NH
363AS0400X
Surgical Physician Assistant
Primary
PA130018
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01Y005045NH02
ANTHEM BCBS MCH
NH
01
—
01Y005045NH03
ANTHEM BCBS MOA
NH
05
—
30334821
—
NH
Enumeration date
12/18/2006
Last updated
09/24/2010
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