Provider Demographics
NPI:1366799652
Name:PACK-CAMPBELL, STEFANIE (LPN)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:PACK-CAMPBELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 ELM CIR
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1528
Mailing Address - Country:US
Mailing Address - Phone:315-884-2366
Mailing Address - Fax:
Practice Address - Street 1:1116 ELM CIR
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1528
Practice Address - Country:US
Practice Address - Phone:315-884-2366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297825164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse