Individual
ELIZABETH MANCUSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 606-7264
(903) 525-1254
Mailing address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 606-7264
(903) 525-1254
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1045851
TX
363LF0000X
Family Nurse Practitioner
95012932
CA
Other
Enumeration date
01/15/2020
Last updated
05/09/2024
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