Individual
CHARLOTTE MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5801 BROADWAY EXT, OKLAHOMA CITY, OK 73118-7482
(405) 424-7711
Mailing address
5801 BROADWAY EXT, OKLAHOMA CITY, OK 73118-7482
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
06/06/2023
Last updated
06/06/2023
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