Healthcare Provider Details

I. General information

NPI: 1295642973
Provider Name (Legal Business Name): GENEVA MACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11290 W GRIER RD
MARANA AZ
85653-9609
US

IV. Provider business mailing address

10819 E SCENIC VERANDA DR
VAIL AZ
85641-2458
US

V. Phone/Fax

Practice location:
  • Phone: 520-682-3243
  • Fax:
Mailing address:
  • Phone: 520-682-3243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number339929
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: