Healthcare Provider Details

I. General information

NPI: 1558822767
Provider Name (Legal Business Name): ANNA SHUSHARINA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 08/31/2024
Certification Date: 08/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 HUDSON CT
HOLLAND PA
18966-2754
US

IV. Provider business mailing address

2500 MARYLAND RD STE 400
WILLOW GROVE PA
19090-1225
US

V. Phone/Fax

Practice location:
  • Phone: 267-991-5053
  • Fax:
Mailing address:
  • Phone: 215-481-4143
  • Fax: 215-481-6790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP020071
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP020071
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP026823
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NR01137000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: