Individual
MRS. SOUNDRA D MACKAVICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
44405 WOODWARD AVE, PONTIAC, MI 48341-5023
(248) 858-6591
Mailing address
580 GRIXDALE LN, WATERFORD, MI 48328-3430
(248) 681-3622
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2488088
MI
Other
Enumeration date
11/29/2009
Last updated
11/29/2009
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