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1710095484 NPI number — ELIZABETH A PACKHEM RN LCDCS CD

NPI Number: 1710095484
Health Care Provider/Practitioner: ELIZABETH A PACKHEM RN LCDCS CD

Information about “1710095484” NPI (ELIZABETH A PACKHEM RN LCDCS CD) exists in 1710095484 in HTML format HTML  |  1710095484 in plain Text format TXT  |  1710095484 in PDF (Portable Document Format) PDF  |  1710095484 in an XML format XML  formats.

NPI Number : 1710095484 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1710095484",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PACKHEM",
    "FirstName": "ELIZABETH",
    "MiddleName": "A",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "RN  LCDCS  CD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MCHALE",
    "OtherFirstName": "ELIZABETH",
    "OtherMiddleName": "A",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "RN",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "166 VINEYARD RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WARWICK",
    "MailingAddressStateName": "RI",
    "MailingAddressPostalCode": "02889",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "401-737-7941",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "70 MINNESOTA AVE",
    "SecondLinePracticeLocationAddress": "THE KENT CENTER",
    "PracticeLocationAddressCityName": "WARWICK",
    "PracticeLocationAddressStateName": "RI",
    "PracticeLocationAddressPostalCode": "02888",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "401-738-0685",
    "PracticeLocationAddressFaxNumber": "401-738-4413",
    "EnumerationDate": "08/25/2006",
    "LastUpdateDate": "09/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "LCDCS 00014",
          "LicenseNumberStateCode": "RI",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "RN08467",
          "LicenseNumberStateCode": "RI",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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