| NPI | 1174832646 |
|---|---|
| Former Name | ANNA MORRISA MACK (MAIDEN NAME) |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-004695) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 4721) |
| Enumeration Date | 2010-10-01 |
| Last Update Date | 2013-07-23 |