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Individual

MRS. SHIRLEY A. MACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
8486 S HUNNIC DR, TUCSON, AZ 85747-5989
(520) 777-8686
Mailing address
8486 S HUNNIC DR, TUCSON, AZ 85747-5989
(520) 777-8686

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
460924
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
460924
LICENSING CERTIFICATION
AZ
Enumeration date
03/21/2008
Last updated
03/21/2008
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