Provider Demographics
NPI:1366076887
Name:PACK, EMMELINE FAYE (DEM)
Entity type:Individual
Prefix:
First Name:EMMELINE
Middle Name:FAYE
Last Name:PACK
Suffix:
Gender:F
Credentials:DEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 BELLE WATLIN CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6266
Mailing Address - Country:US
Mailing Address - Phone:385-425-8434
Mailing Address - Fax:
Practice Address - Street 1:294 BELLE WATLIN CT
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-6266
Practice Address - Country:US
Practice Address - Phone:385-425-8434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula
No376J00000XNursing Service Related ProvidersHomemaker