Individual
MEGAN MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2773 APPLEWOOD DR, COLORADO CITY, CO 81019
(719) 248-1745
Mailing address
PO BOX 152, RYE, CO 81069-0152
(719) 248-1745
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
NA. 00767599
CO
Other
Enumeration date
10/20/2016
Last updated
10/20/2016
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