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General NPI Number Information
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NPI Number | 1730505942
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Entity Type | Individual
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Provider Name | SHEKELA JOINER MACK MSN, CRNP
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Gender | Female
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Dates
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Enumeration Date | 03/12/2014
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 1700 6TH AVE SOUTH WIC 7TH FLOOR - HOSU
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City | BIRMINGHAM
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State | AL
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Zip | 35294
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Country | US
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Telephone | 205-934-9787
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Fax | 205-934-0655
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Provider Business Mailing Address
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Address Line | 1484 STONEYKIRK RD
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City | PELHAM
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State | AL
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Zip | 35124-6217
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Country | US
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Telephone | 205-934-9787
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Fax | 205-934-0655
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 1-113721
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License Number State | AL
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