Healthcare Provider Details

I. General information

NPI: 1033536669
Provider Name (Legal Business Name): CINDY PACKARD L.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 E GEMINI ST
GILBERT AZ
85234-4019
US

IV. Provider business mailing address

2905 E GEMINI ST
GILBERT AZ
85234-4019
US

V. Phone/Fax

Practice location:
  • Phone: 480-747-4451
  • Fax: 480-981-0897
Mailing address:
  • Phone: 480-747-4451
  • Fax: 480-981-0897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number079
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: