Individual
MARISA DIANNA MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12180 PARK AVE S, TACOMA, WA 98447-0001
(253) 535-7411
Mailing address
12180 PARK AVE S, TACOMA, WA 98447-0001
(253) 535-7411
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN61087194
WA
Other
Enumeration date
03/31/2026
Last updated
03/31/2026
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