Provider Demographics
NPI:1780579854
Name:GOCHNOUR, MARISSA ELAINE
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:ELAINE
Last Name:GOCHNOUR
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 W 4100 S STE 250
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-5434
Mailing Address - Country:US
Mailing Address - Phone:801-582-5534
Mailing Address - Fax:
Practice Address - Street 1:3725 W 4100 S STE 250
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-5434
Practice Address - Country:US
Practice Address - Phone:801-582-5534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program