Healthcare Provider Details

I. General information

NPI: 1811224439
Provider Name (Legal Business Name): MARY ESTHER KANFOUSH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ESTHER RODGERS

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 STATE ROUTE 288
ELLWOOD CITY PA
16117-3055
US

IV. Provider business mailing address

200 OHIO RIVER BLVD
BADEN PA
15005-1914
US

V. Phone/Fax

Practice location:
  • Phone: 724-773-4681
  • Fax: 724-770-7966
Mailing address:
  • Phone: 724-773-6802
  • Fax: 724-770-7919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP010542
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: