Healthcare Provider Details

I. General information

NPI: 1659796852
Provider Name (Legal Business Name): CHRISTINE MARROCCO RN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N TELEGRAPH RD STE 300
PONTIAC MI
48341-1039
US

IV. Provider business mailing address

600 N TELEGRAPH RD STE 300
PONTIAC MI
48341-1039
US

V. Phone/Fax

Practice location:
  • Phone: 248-745-4900
  • Fax:
Mailing address:
  • Phone: 248-745-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704384830
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: