MEDICARE: MS. MICHELE C 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	363LP2300X	Primary Care Nurse Practitioner	RN396527	CA

General Provider Information

NPI Number	:	1609806272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELE C MACK NP

Provider Business Mailing Address
First Line	:	16111 PLUMMER ST
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-2036
Country	:	US
Telephone Number	:	818-891-7711
Fax Number	:	818-895-8453

Provider Business Practice Location Address
First Line	:	16111 PLUMMER ST
Second Line	:	BLDG #200 RM#3411
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-2036
Country	:	US
Telephone Number	:	818-891-7711
Fax Number	:	818-895-9453

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	09/19/2014

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