Individual
MS. TERESA CHANELLE MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
8605 N GRANVILLE RD, APT.6, MILWAUKEE, WI 53224-2368
(414) 366-0912
Mailing address
8605 N GRANVILLE RD, APT.6, MILWAUKEE, WI 53224-2368
(414) 366-0912
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
309311-31
WI
Other
Enumeration date
07/07/2011
Last updated
07/07/2011
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