Individual
ANNETTE MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
6909 S 38TH DR, PHOENIX, AZ 85041-6195
(602) 446-8474
Mailing address
6909 S 38TH DR, PHOENIX, AZ 85041-6195
(602) 446-8474
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP041359
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LP041359
LICENSE
AZ
Enumeration date
10/12/2009
Last updated
10/12/2009
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