Individual
MARK R MARNOCHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
229 S MORRISON ST, FOX VALLEY FAMILY MEDICINE, APPLETON, WI 54911-5725
(920) 997-8409
Mailing address
W8553 HICKORY CT, HORTONVILLE, WI 54944-9651
(920) 779-0406
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1671
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427082312
—
WI
Enumeration date
07/10/2006
Last updated
04/16/2018
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