Individual
MEGAN G PACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
525 NW LAKE WHITNEY PL STE 102, PORT ST LUCIE, FL 34986-1605
(772) 337-8164
Mailing address
1810 BLUE HERON LN, FORT PIERCE, FL 34982-8049
(772) 332-0902
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000000000
—
FL
Enumeration date
10/31/2017
Last updated
10/31/2017
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