Healthcare Provider Details

I. General information

NPI: 1134301369
Provider Name (Legal Business Name): CHERRY NICOLE MACK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 HILL RD N
PICKERINGTON OH
43147-8666
US

IV. Provider business mailing address

PO BOX 932958
CLEVELAND OH
44193-0028
US

V. Phone/Fax

Practice location:
  • Phone: 614-328-0341
  • Fax: 614-645-1347
Mailing address:
  • Phone: 614-859-1906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP0032500
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: