Provider Demographics
NPI:1174125009
Name:MORICONI, JOHN ANTHONY
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ANTHONY
Last Name:MORICONI
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 1:1408 LANDS END CIR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9537
Mailing Address - Country:US
Mailing Address - Phone:614-271-1400
Mailing Address - Fax:
Practice Address - Street 1:1380 DUBLIN RD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1025
Practice Address - Country:US
Practice Address - Phone:614-488-7117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.176255.MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse