Healthcare Provider Details

I. General information

NPI: 1619992559
Provider Name (Legal Business Name): MICHELLE PACKARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
LEBANON NH
03756-1000
US

IV. Provider business mailing address

364 NORWICH AVE
WILDER VT
05088
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-4897
  • Fax: 603-650-4560
Mailing address:
  • Phone: 802-295-2420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberH475
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: