Individual
VANESSA MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
46114 506TH ST, NICOLLET, MN 56074-4003
(507) 276-1463
Mailing address
46114 506TH ST, NICOLLET, MN 56074-4003
(507) 276-1463
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1040868
MN
Other
Enumeration date
04/24/2023
Last updated
04/24/2023
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