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Individual

MRS. LINDA RUTH MACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
1500 E WOODROW WILSON AVE, JACKSON, MS 39216-5116
(601) 362-4471
(601) 362-1259
Mailing address
1973 HOUSTON RD, BOLTON, MS 39041-9387
(601) 362-4461
(601) 364-1259

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R725005
MS

Other

Enumeration date
09/22/2006
Last updated
07/08/2007
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