Individual
MRS. GINA M. WACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,RD
Contact information
Practice address
127 SPRING OAK DR, MADISON, MS 39110-9131
(601) 605-9382
Mailing address
127 SPRING OAK DR, MADISON, MS 39110-9131
(601) 605-9382
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D0500
MS
Other
Enumeration date
03/17/2008
Last updated
03/17/2008
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