Provider Demographics
NPI:1083181192
Name:MARRONI, ELIZA R (PMHNP)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:R
Last Name:MARRONI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:ELIZA
Other - Middle Name:R
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2846 GRAND VIEW CT
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6885
Mailing Address - Country:US
Mailing Address - Phone:734-546-8133
Mailing Address - Fax:866-206-8423
Practice Address - Street 1:2846 GRAND VIEW CT
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6885
Practice Address - Country:US
Practice Address - Phone:734-546-8133
Practice Address - Fax:866-206-8423
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994584-NP363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704293680OtherSTATE OF MICHIGAN