Individual
DR. BILLIE CANDICE PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4230 N ROXBORO ST, DURHAM, NC 27704-1826
(919) 477-9805
Mailing address
9 CRESTMONT CT., DURHAM, NC 27703-9480
(412) 657-5245
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
OS012220
PA
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2011-01899
NC
208100000X
Physical Medicine & Rehabilitation Physician
N2226
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001894130
—
PA
01
—
613851
MEDICARE PTAN
TX
01
—
NC47140281
MEDICARE PTAN
NC
Enumeration date
02/21/2006
Last updated
03/05/2012
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