| Doctor Name: | KATHLEEN ANN MACK |
| NPI Number: | 1326211624 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | RN00106768 |
| Business Practice Address: | 612 Country Clb Tooele, UT - 840749604 |
| Business Phone Number: | 5097315662 |
| Business Fax Number: | |
| Mailing Address: | 612 Country Clb, TOOELE |
| State: | UT |
| Postal Code: | 840749604 |
| Phone Number: | 5097315662 |
| Fax Number: | |
| NPI Enumeration Date: | 04/08/2008 |
| NPI Last Update Date: | 08/09/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0808X |
| License Number: | RN00106768 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |