Individual
MISS KRISTEN ELIZABETH MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
40622 119TH ST, GENOA CITY, WI 53128-2501
(847) 445-6942
Mailing address
40622 119TH ST, GENOA CITY, WI 53128
(847) 445-6942
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
171602-30
WI
Other
Enumeration date
11/13/2010
Last updated
11/13/2010
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