Provider Demographics
NPI:1306220363
Name:GONCZY, MARCY (CNP)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:GONCZY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEMORY LN # 200
Mailing Address - Street 2:
Mailing Address - City:GARRETTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44231-9443
Mailing Address - Country:US
Mailing Address - Phone:330-527-3937
Mailing Address - Fax:
Practice Address - Street 1:1 MEMORY LN # 200
Practice Address - Street 2:
Practice Address - City:GARRETTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44231-9443
Practice Address - Country:US
Practice Address - Phone:330-527-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17648-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily