Individual
MS. LISA S MANCUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
523 PLYMOUTH RD, PLYMOUTH MEETING, PA 19462-1656
(215) 956-5110
Mailing address
3803 W CHESTER PIKE STE 160, NEWTOWN SQUARE, PA 19073-2336
(484) 337-1260
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
UP006270C
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018240920001
—
PA
Enumeration date
06/21/2006
Last updated
08/18/2021
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