Most Relevant Information
Provider Data
| NPI Number: | 1003061839 |
| Provider Name: | TRUDY JOHNETTE MACK LPN |
| Entity Type: | Individual |
| Taxonomy Code: | 164W00000X |
| Specialty: | Licensed Practical Nurse |
| License Number: | 284904 |
Most Important Dates
| Enumeration Date: | 11/20/2008 |
| Last Updated: | 11/20/2008 |
Provider Practice Location
165 N. WATER STREET
APT. 205
ROCHESTER
NY
14604
Practice Location Phone/Fax
| Phone: | 5852860097 |
| Fax: |
Provider Mailing Location
165 N. WATER STREET
APT. 205
ROCHESTER
NY
14604
Provider Mailing Phone/Fax
| Phone: | 5852860097 |
| Fax: |