Individual
MRS. JESSICA LEIGH MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
1 MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2011
Mailing address
5515 OLD MEADOW RD, CHARLOTTE, NC 28227-2677
(828) 289-9211
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
254774
NC
363L00000X
Nurse Practitioner
Primary
5012459
NC
363LC0200X
Critical Care Medicine Nurse Practitioner
5012459
NC
Other
Enumeration date
10/27/2019
Last updated
10/29/2019
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