Provider Demographics
NPI:1063909570
Name:MARCHESE, ANTHONY
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:MARCHESE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9640 N AMERICAN RANCH RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-9042
Mailing Address - Country:US
Mailing Address - Phone:928-821-2957
Mailing Address - Fax:
Practice Address - Street 1:9640 N AMERICAN RANCH RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-9042
Practice Address - Country:US
Practice Address - Phone:928-821-2957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8717284171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator