Individual
ANGELA E MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
2000 LAKE AVE, WOODSTOCK, IL 60098-7401
(815) 337-7100
Mailing address
2000 LAKE AVE, WOODSTOCK, IL 60098-7401
(815) 337-7100
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
1794-029
WI
133V00000X
Registered Dietitian
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1794-029
LICENSE
WI
Enumeration date
10/04/2006
Last updated
07/08/2007
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