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General NPI Number Information
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NPI Number | 1609806272
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Entity Type | Individual
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Provider Name | MICHELE C MACK NP
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Gender | Female
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 16111 PLUMMER ST BLDG #200 RM#3411
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City | NORTH HILLS
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State | CA
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Zip | 91343-2036
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Country | US
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Telephone | 818-891-7711
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Fax | 818-895-9453
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Provider Business Mailing Address
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Address Line | 16111 PLUMMER ST
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City | NORTH HILLS
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State | CA
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Zip | 91343-2036
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Country | US
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Telephone | 818-891-7711
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Fax | 818-895-8453
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | RN396527
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License Number State | CA
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