Healthcare Provider Details

I. General information

NPI: 1548291990
Provider Name (Legal Business Name): CHRISTINE E KUSHNER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 S BRADY ST STE 205
DU BOIS PA
15801-2159
US

IV. Provider business mailing address

3 S BRADY ST STE 205
DU BOIS PA
15801-2159
US

V. Phone/Fax

Practice location:
  • Phone: 814-371-1088
  • Fax: 814-371-4966
Mailing address:
  • Phone: 814-371-1088
  • Fax: 814-371-4966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP021515
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN274879L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: