Provider Demographics
NPI:1861957383
Name:MRACHINA, JOHN (FNP-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MRACHINA
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19612 HUDSON RIVER DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-4242
Mailing Address - Country:US
Mailing Address - Phone:586-381-9833
Mailing Address - Fax:
Practice Address - Street 1:44347 DELACROIX LN
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-3120
Practice Address - Country:US
Practice Address - Phone:586-381-9833
Practice Address - Fax:888-770-1688
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704288924363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily