Provider Demographics
NPI:1447223946
Name:MACK, CINDY (CNM)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:MACK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:
Other - Last Name:MACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM
Mailing Address - Street 1:135 N UNION ST
Mailing Address - Street 2:STCHCN/UPC
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2736
Mailing Address - Country:US
Mailing Address - Phone:716-375-7500
Mailing Address - Fax:716-701-6853
Practice Address - Street 1:135 N UNION ST
Practice Address - Street 2:UNIVERSAL PRIMARY CARE
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2736
Practice Address - Country:US
Practice Address - Phone:716-375-7500
Practice Address - Fax:716-701-6852
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000978163W00000X, 176B00000X
NYF000978367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02152692Medicaid
NYRA2331Medicare UPIN
NY02152692Medicaid