Individual
EILEEN M PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
322 E CECIL AVE # 1, NORTH EAST, MD 21901-4012
(410) 287-5570
Mailing address
322 E CECIL AVE # 1, NORTH EAST, MD 21901-4012
(410) 287-5570
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AC001006
MD
363L00000X
Nurse Practitioner
Primary
R125856
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MD
Enumeration date
02/20/2012
Last updated
04/01/2013
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