Provider Demographics
NPI:1609806272
Name:MACK, MICHELE C (NP)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:C
Last Name:MACK
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:16111 PLUMMER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-2036
Mailing Address - Country:US
Mailing Address - Phone:818-891-7711
Mailing Address - Fax:818-895-8453
Practice Address - Street 1:16111 PLUMMER ST
Practice Address - Street 2:BLDG #200 RM#3411
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-2036
Practice Address - Country:US
Practice Address - Phone:818-891-7711
Practice Address - Fax:818-895-9453
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CARN396527363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care