Healthcare Provider Details

I. General information

NPI: 1023084837
Provider Name (Legal Business Name): ELENA C. CASANOVA-GHOSH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELENA C. HOLMES

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE SUITE 356 LANKENAU MOB EAST
WYNNEWOOD PA
19096-3450
US

IV. Provider business mailing address

100 E LANCASTER AVE SUITE 356 LANKENAU MOB EAST
WYNNEWOOD PA
19096-3450
US

V. Phone/Fax

Practice location:
  • Phone: 484-476-8210
  • Fax: 610-552-0029
Mailing address:
  • Phone: 484-476-8210
  • Fax: 610-552-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberVP006089P
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: