Healthcare Provider Details

I. General information

NPI: 1861957383
Provider Name (Legal Business Name): JOHN MRACHINA FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44347 DELACROIX LN
CLINTON TOWNSHIP MI
48038-3120
US

IV. Provider business mailing address

19612 HUDSON RIVER DR
MACOMB MI
48044-4242
US

V. Phone/Fax

Practice location:
  • Phone: 586-381-9833
  • Fax: 888-770-1688
Mailing address:
  • Phone: 586-381-9833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704288924
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704288924
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: