Provider Demographics
NPI:1902036809
Name:MACK, VALERIE SUE (RN)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:SUE
Last Name:MACK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-0956
Mailing Address - Country:US
Mailing Address - Phone:740-450-3902
Mailing Address - Fax:
Practice Address - Street 1:3300 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-0956
Practice Address - Country:US
Practice Address - Phone:740-450-3902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN261459163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse