Provider Demographics
NPI:1326582040
Name:MANCUSO, CAREY ANN (NP)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:ANN
Last Name:MANCUSO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CAREY
Other - Middle Name:ANN
Other - Last Name:FACELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 E NORTH AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4756
Mailing Address - Country:US
Mailing Address - Phone:412-359-3115
Mailing Address - Fax:412-359-3165
Practice Address - Street 1:320 E NORTH AVE FL 3
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4756
Practice Address - Country:US
Practice Address - Phone:412-359-3115
Practice Address - Fax:412-359-3165
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016920363LF0000X
WV100326363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103704461Medicaid
13989478OtherCAQH