Healthcare Provider Details

I. General information

NPI: 1013981083
Provider Name (Legal Business Name): CINDY H PACKER CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRIAR KNOLL CT STE 1
FISHERSVILLE VA
22939-2635
US

IV. Provider business mailing address

PO BOX 4127
ROANOKE VA
24015-0127
US

V. Phone/Fax

Practice location:
  • Phone: 540-949-0955
  • Fax: 540-949-8377
Mailing address:
  • Phone: 940-981-9394
  • Fax: 540-344-7154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number0024165889
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024165889
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: