Provider Demographics
NPI:1740566959
Name:MACK, EMILY SILVA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:SILVA
Last Name:MACK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:EMILY
Other - Middle Name:S
Other - Last Name:MACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:2235 DOUGLAS BLVD STE 510
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4266
Mailing Address - Country:US
Mailing Address - Phone:916-446-4449
Mailing Address - Fax:916-446-9370
Practice Address - Street 1:2235 DOUGLAS BLVD STE 510
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4266
Practice Address - Country:US
Practice Address - Phone:916-446-4449
Practice Address - Fax:916-446-9370
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20358363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily