Individual
MARQUITA MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICENSED PRACTICAL N
Contact information
Practice address
960A HARVEST DR # 100, BLUE BELL, PA 19422-1991
(215) 421-8093
(484) 640-5994
Mailing address
5836 N HOPE ST, PHILA, PA 19120-2412
(215) 421-8093
(484) 640-5994
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN312757
PA
Other
Enumeration date
04/24/2024
Last updated
05/09/2024
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