Individual
MRS. ALICIA MAE MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
212 S. 4TH ST. SUITE 301, SPECTRA HEALTH, GRAND FORKS, ND 58201
(701) 757-2100
(701) 757-2813
Mailing address
212 S. 4TH ST. SUITE 301, SPECTRA HEALTH, GRAND FORKS, ND 58201
(701) 757-2100
(701) 757-2813
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2344340
MN
163W00000X
Registered Nurse
R39910
ND
363LF0000X
Family Nurse Practitioner
Primary
R39910
ND
Other
Enumeration date
06/25/2018
Last updated
02/24/2020
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