Provider Demographics
NPI:1154216141
Name:MARCHETTI, ELISE MICHELE
Entity type:Individual
Prefix:MRS
First Name:ELISE
Middle Name:MICHELE
Last Name:MARCHETTI
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ELISE
Other - Middle Name:MICHELE
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:318 REYNARD DR
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-2724
Mailing Address - Country:US
Mailing Address - Phone:843-518-7441
Mailing Address - Fax:
Practice Address - Street 1:318 REYNARD DR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-2724
Practice Address - Country:US
Practice Address - Phone:843-518-7441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant