MEDICARE: MRS. HOPE ELIZABETH PACK FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	249394	AZ

General Provider Information

NPI Number	:	1043812142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOPE ELIZABETH PACK FNP

Provider Business Mailing Address
First Line	:	101 W SEMINOLE DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85023-5277
Country	:	US
Telephone Number	:	602-989-2193
Fax Number	:

Provider Business Practice Location Address
First Line	:	9305 W THOMAS RD STE 305
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-3366
Country	:	US
Telephone Number	:	623-478-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2020
Last Update Date	:	09/20/2023

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