| Doctor Name: | SUSAN J MACK |
| NPI Number: | 1396955316 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, FNP |
| License Number: | 070430 |
| Business Practice Address: | 929 Stacy Burk Drive Flora, IL - 62839 |
| Business Phone Number: | 6186622191 |
| Business Fax Number: | |
| Mailing Address: | 608 N Main St, FLORA |
| State: | IL |
| Postal Code: | 628391406 |
| Phone Number: | 6186624246 |
| Fax Number: | |
| NPI Enumeration Date: | 05/22/2007 |
| NPI Last Update Date: | 05/06/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 070430 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |