Active NPI
Susan Kathleen Pack, RN
- Registered Nurse
- Delaware, OH
National Provider Identifier
1013045764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN 149278
- Practice address
- 1089 N Old State Rd
Delaware, OH 43015-9450 - Phone
- (740) 524-5006
- Fax
- (740) 524-4021
- NPI assigned
- Mar 2, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN 149278 | OH | Primary |
Addresses
Primary practice location
1089 N Old State Rd
Delaware, OH 43015-9450
Mailing address
1089 N Old State Rd
Delaware, OH 43015-9450
Phone (740) 524-5006
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN 149278 | OH | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013045764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1089 N OLD STATE RD",
"city": "DELAWARE",
"state": "OH",
"postal_code": "430159450",
"telephone_number": "740-524-5006",
"fax_number": "740-524-4021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1089 N OLD STATE RD",
"city": "DELAWARE",
"state": "OH",
"postal_code": "430159450",
"telephone_number": "740-524-5006",
"fax_number": "740-524-4021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACK",
"first_name": "SUSAN",
"middle_name": "KATHLEEN",
"name_prefix": "Mrs.",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "OH",
"license": "RN 149278",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Delaware, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.