Healthcare Provider Details

I. General information

NPI: 1245485580
Provider Name (Legal Business Name): ELIZABETH KUSTURISS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E EVESHAM RD STE 110
VOORHEES NJ
08043-4502
US

IV. Provider business mailing address

919 CONESTOGA RD BUILDING 1, SUITE 300
BRYN MAWR PA
19010-1352
US

V. Phone/Fax

Practice location:
  • Phone: 888-982-3726
  • Fax: 856-762-2732
Mailing address:
  • Phone: 610-565-6580
  • Fax: 610-525-3664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberSP012040
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11544
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number000000000
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number26NJ00927900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: