Provider Demographics
NPI:1902545718
Name:MARCACCI, ELEONORA MARIE
Entity Type:Individual
Prefix:
First Name:ELEONORA
Middle Name:MARIE
Last Name:MARCACCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2613 E 2900 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1842
Mailing Address - Country:US
Mailing Address - Phone:801-712-8325
Mailing Address - Fax:
Practice Address - Street 1:2613 E 2900 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1842
Practice Address - Country:US
Practice Address - Phone:801-712-8325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program