Individual
DANIELLE MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CHLS
Contact information
Practice address
4611 PEACHTREE AVE, LOUISVILLE, KY 40215-2442
(502) 794-7008
Mailing address
4611 PEACHTREE AVE, LOUISVILLE, KY 40215-2442
(502) 794-7008
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
208622
KY
Other
Enumeration date
03/01/2018
Last updated
03/01/2018
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