Individual
GENEVIEVE D. MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
84 MARGINAL WAY STE 1000, PORTLAND, ME 04101-2477
(207) 774-4092
Mailing address
100 GANNETT DR STE C, SOUTH PORTLAND, ME 04106-5900
(207) 347-2947
(207) 874-2317
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
216149
NC
Other
Enumeration date
06/15/2005
Last updated
03/04/2026
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