Individual
ANGELIA MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1907 1/2 SEMPLE AVE, SAINT LOUIS, MO 63112-4307
(314) 303-9901
Mailing address
1907 1/2 SEMPLE AVE, SAINT LOUIS, MO 63112-4307
(314) 303-9901
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
1999135071
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013215128
—
MO
Enumeration date
08/01/2014
Last updated
08/01/2014
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