MEDICARE: MS. ELISABETH ROSE LUGANO CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	SP023409	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SP023409	OTHER	PA	PENNSYLVANIA DEPARTMENT OF STATE

General Provider Information

NPI Number	:	1811572308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELISABETH ROSE LUGANO CRNP

Provider Business Mailing Address
First Line	:	8121 CEDAR RD
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-2136
Country	:	US
Telephone Number	:	267-455-5289
Fax Number	:

Provider Business Practice Location Address
First Line	:	8121 CEDAR RD
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-2136
Country	:	US
Telephone Number	:	267-455-5289
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2021
Last Update Date	:	03/16/2021

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