Provider Demographics
NPI:1508822644
Name:MACK, ANN KATHRYN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:KATHRYN
Last Name:MACK
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 OAK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48855-7358
Mailing Address - Country:US
Mailing Address - Phone:517-546-6369
Mailing Address - Fax:
Practice Address - Street 1:138 W HIGHLAND RD STE 950
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-2196
Practice Address - Country:US
Practice Address - Phone:517-545-2400
Practice Address - Fax:888-258-0150
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704131405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner