Provider Demographics
NPI:1457793168
Name:MACK, ARICA L (RN)
Entity Type:Individual
Prefix:
First Name:ARICA
Middle Name:L
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 1:319 S WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-1673
Mailing Address - Country:US
Mailing Address - Phone:336-285-7915
Mailing Address - Fax:336-285-7933
Practice Address - Street 1:319 S WESTGATE DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1673
Practice Address - Country:US
Practice Address - Phone:336-285-7915
Practice Address - Fax:336-285-7933
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC244785163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse