Provider Demographics
NPI:1568346534
Name:MACK, DONNA V (RN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:V
Last Name:MACK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:2850 LEAMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:EQUALITY
Mailing Address - State:IL
Mailing Address - Zip Code:62934-2634
Mailing Address - Country:US
Mailing Address - Phone:618-926-1236
Mailing Address - Fax:618-294-8381
Practice Address - Street 1:946 4TH ST
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:IL
Practice Address - Zip Code:62930-1204
Practice Address - Country:US
Practice Address - Phone:618-499-2266
Practice Address - Fax:618-294-8313
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL041.400580163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health