Individual
MS. VICKIE ROCHELLE MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
811 ALVAREDO ST, JACKSON, MS 39204-5317
(601) 372-8941
Mailing address
811 ALVAREDO ST, JACKSON, MS 39204-5317
(601) 372-8941
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P122165
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00770172
—
MS
Enumeration date
10/17/2006
Last updated
07/09/2007
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