Provider Demographics
NPI:1255984886
Name:MARCHINCHIN, NICOLAS JOHN (CNP)
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:JOHN
Last Name:MARCHINCHIN
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 E 324TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095-3323
Mailing Address - Country:US
Mailing Address - Phone:440-666-8185
Mailing Address - Fax:
Practice Address - Street 1:36100 EUCLID AVE STE 120
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4426
Practice Address - Country:US
Practice Address - Phone:440-951-8360
Practice Address - Fax:440-951-9408
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025100363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner