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General NPI Number Information
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NPI Number | 1366090409
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Entity Type | Individual
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Provider Name | EMILY PACK NP
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Gender | Female
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Dates
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Enumeration Date | 09/02/2019
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Last Update Date | 11/25/2020
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Provider Practice Location Address
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Address Line | 1650 SKYLYN DR STE 120
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City | SPARTANBURG
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State | SC
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Zip | 29307-1069
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Country | US
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Telephone | 864-216-4525
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Fax | 864-216-4514
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Provider Business Mailing Address
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Address Line | PO BOX 743070
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City | ATLANTA
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State | GA
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Zip | 30374-3070
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Country | US
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Telephone | 864-560-4304
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Fax | 864-560-4413
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 22603
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License Number State | SC
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