Individual
MARY MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
3400 188TH ST SW STE 241, LYNNWOOD, WA 98037-4792
(346) 376-1702
Mailing address
17855 DALLAS PKWY STE 200, DALLAS, TX 75287-6857
(800) 834-3059
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95014527
CA
363LF0000X
Family Nurse Practitioner
Primary
AP.61599107
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95014527
NP LICENSE
CA
Enumeration date
05/05/2020
Last updated
07/23/2026
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