Individual
FELISHA MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1635 CENTRAL AVE, BRIDGEPORT, CT 06610-2717
(475) 439-9331
Mailing address
1635 CENTRAL AVE, BRIDGEPORT, CT 06610-2717
(475) 439-9331
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
007383
CT
Other
Enumeration date
11/28/2017
Last updated
11/28/2017
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