MEDICARE: ARICA L MACK NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	244785	NC
2	363LF0000X	Family Nurse Practitioner	5020718	NC

General Provider Information

NPI Number	:	1457793168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARICA L MACK NP

Provider Business Mailing Address
First Line	:	1109 E WENDOVER AVE STE A
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-6778
Country	:	US
Telephone Number	:	336-907-6318
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 CENTERVIEW DR STE 105
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-3709
Country	:	US
Telephone Number	:	336-378-0109
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2013
Last Update Date	:	08/22/2024

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