Basic Information
| Provider Information | |||||||||
| NPI: | 1275933178 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PACKER | ||||||||
| FirstName: | ACACIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SZWEDA | ||||||||
| OtherFirstName: | ACACIA | ||||||||
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| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1501 N CAMPBELL AVE | ||||||||
| Address2: | PO BOX 245085 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857245085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206947432 | ||||||||
| FaxNumber: | 5206946688 | ||||||||
| Practice Location | |||||||||
| Address1: | 3043 W INA RD STE 115 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857412107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207977070 | ||||||||
| FaxNumber: | 5207977077 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2014 | ||||||||
| LastUpdateDate: | 03/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | R2505 | AZ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.