Provider Demographics
NPI:1568128395
Name:MARCONI, IAN M (MSN,RN, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:M
Last Name:MARCONI
Suffix:
Gender:M
Credentials:MSN,RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10477 LIBERTY RD S
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9303
Mailing Address - Country:US
Mailing Address - Phone:614-208-3740
Mailing Address - Fax:
Practice Address - Street 1:10477 LIBERTY RD S
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-9303
Practice Address - Country:US
Practice Address - Phone:614-208-3740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLE-00038409363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health