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General NPI Number Information
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NPI Number | 1417173410
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Entity Type | Individual
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Provider Name | TANYA MARIE MACK NP
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Gender | Female
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6700 MD ANDERSON BLVD. BLDG. 10
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City | HOUSTON
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State | TX
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Zip | 77030-3303
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Country | US
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Telephone | 713-795-5380
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Fax | 713-795-5962
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Provider Business Mailing Address
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Address Line | 6700 M.D. ANDERSON BLVD. BLDG. 10
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City | HOUSTON
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State | TX
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Zip | 77030-3303
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Country | US
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Telephone | 713-795-5380
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Fax | 713-795-5962
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 501434
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License Number State | TX
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