Individual
MR. DEWAYNE W MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
REGISTERED NURSE
Contact information
Practice address
8119 HOLLAND RD, ALEXANDRIA, VA 22306-3135
(703) 360-6910
Mailing address
8119 HOLLAND RD, ALEXANDRIA, VA 22306-3135
(703) 360-6910
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
0001142876
VA
Other
Enumeration date
12/14/2010
Last updated
12/14/2010
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