Individual
DEAI MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1738 TUXWORTH AVE, CINCINNATI, OH 45238-4036
(513) 372-2286
Mailing address
1738 TUXWORTH AVE, CINCINNATI, OH 45238-4036
(513) 372-2286
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
162956
OH
Other
Enumeration date
03/24/2021
Last updated
03/24/2021
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