MRS. ALICIA MAE MACK (NPI# 1225523004) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225523004 |
| Entity Type | Individual |
| Full Name | MRS. ALICIA MAE MACK |
| Other Name | MISS ALICIA MAE ERICKSON |
| Credential | FNP-C |
| Practice Address |
212 S. 4th St. Suite 301 Spectra Health Grand Forks ND 58201 |
| Practice Telephone | 7017572100 |
| Practice Fax Number | 7017572813 |
| Mailing Telephone | 7017572100 |
| Mailing Fax Number | 7017572813 |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2020-02-24 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 2344340 | MN | Nursing Service Providers |
| N | 163W00000X | Registered Nurse | R39910 | ND | Nursing Service Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
R39910 | ND | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 607 Towner Ave, Larimore, ND 582514501 | 7013189399 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992314686 | Alicia L Mack | Behavior Technician | 260 Peachtree St Nw Ste 2000, Atlanta, GA 30303-1239 | 2020-07-28 |
| Street Address |
212 S. 4TH ST. SUITE 301 SPECTRA HEALTH |
| City | GRAND FORKS |
| State | ND |
| Zip Code | 58201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255965398 | Development Homes Inc | Intermediate Care Facility, Mentally Retarded | 5509 Cottonwood Street, Grand Forks, ND 58201 | 2020-02-27 |
| 1932753779 | Lydia Pansegrau | Occupational Therapist | 2950 36th Ave S, Apt A-11, Grand Forks, ND 58201 | 2019-07-30 |
| 1407416019 | Kristina Aikens | Optometrist | 1820 S 42nd St, Grand Forks, ND 58201 | 2019-06-17 |
| 1861963209 | Jessica Kovsky | Occupational Therapist | 1375 S Columbia Rd- Altru Performance Center, Grand Forks, ND 58201 | 2018-12-11 |
| 1609345834 | Altru Specialty Services, Inc | Durable Medical Equipment & Medical Supplies | 1375 South Columbia Road, Suite A, Grand Forks, ND 58201 | 2018-11-16 |
| 1396260808 | Amber White | Behavior Technician | 2016 S Washington St., Grand Forks, ND 58201 | 2017-08-04 |
| 1225579840 | Kathleen Suzanne Tillman | Psychologist | 2100 S Columbia Road, Suite 202, Family Institute, PC, Grand Forks, ND 58201 | 2017-03-15 |
| 1881148906 | Melissa Pytlik Monson | Physician Assistant | 1380 S Columbia Rd - Altru Family Medcine Center, Grand Forks, ND 58201 | 2016-08-05 |
| 1477936029 | Laura Jane Carlson | Nurse Practitioner | 3165 Demers Avenue - Truyu Aesthetic Center, Grand Forks, ND 58201 | 2015-07-01 |
| 1215341417 | Benjamin H Roth | Family Medicine | 860 South Columbia Road, Grand Forks, ND 58201 | 2014-06-16 |
| Find all providers in zip 58201 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477163335 | Tabitha Elizabeth Clare Solc | Nurse Practitioner | 5770 Orchid Cir, Grand Forks, ND 58201-3232 | 2020-08-05 |
| 1093233165 | Elizabeth Marie Hodny | Nurse Practitioner | 1451 44th Ave S Ste 112, Grand Forks, ND 58201-3434 | 2017-09-08 |
| 1740686971 | Kristi L Hillman | Nurse Practitioner | 960 South Columbia Road, Grand Forks, ND 58201-4030 | 2014-11-17 |
| 1023075975 | Mary Pat Holler-bibel | Nurse Practitioner | 718 Oak St, Grand Forks, ND 58201-4460 | 2006-04-26 |
| 1982210308 | Kristen Marie Young | Nurse Practitioner | 212 S 4th St Ste 301, Grand Forks, ND 58201-4776 | 2020-09-21 |
| 1306464219 | Leanne Kilzer | Nurse Practitioner | 1300 S Columbia Rd, Grand Forks, ND 58201-4012 | 2020-07-07 |
| 1356972665 | Leslie Erica Rodriguez | Nurse Practitioner | 1380 S Columbia Rd, Grand Forks, ND 58201-4059 | 2020-01-27 |
| 1013559491 | Hannah Nelson | Nurse Practitioner | 4700 S Washington St Ste C, Grand Forks, ND 58201-8155 | 2019-10-17 |
| 1952962128 | Renae Dawn Heider | Nurse Practitioner | 4440 S Washington St- Altru Professional Center, Grand Forks, ND 58201-7245 | 2019-06-27 |
| 1265093124 | Mckenzie Ann Brown | Nurse Practitioner | 3035 Demers Ave, Grand Forks, ND 58201-4040 | 2019-06-21 |
| Find all providers in GRAND FORKS | ||||
| City | GRAND FORKS |
| Zip Code | 58201 |
Please comment or provide details below to improve the information on MRS. ALICIA MAE MACK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.