Individual
CONNIE MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3531 N TAYLOR AVE, SAINT LOUIS, MO 63115-2614
(314) 398-9070
Mailing address
3531 N TAYLOR AVE, SAINT LOUIS, MO 63115-2614
(314) 398-9070
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
02/21/2019
Last updated
02/21/2019
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