Individual
ANITRA MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
5000 PARKSIDE AVE, PHILADELPHIA, PA 19131-4714
(215) 879-6116
Mailing address
311 MACDONALD CLOSE, BEAR, DE 19701-8306
(267) 259-7405
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN305638
PA
Other
Enumeration date
07/19/2023
Last updated
07/19/2023
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