Provider Demographics
NPI:1811224439
Name:KANFOUSH, MARY ESTHER (CRNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ESTHER
Last Name:KANFOUSH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ESTHER
Other - Last Name:RODGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 OHIO RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:BADEN
Mailing Address - State:PA
Mailing Address - Zip Code:15005-1914
Mailing Address - Country:US
Mailing Address - Phone:724-773-6802
Mailing Address - Fax:724-770-7919
Practice Address - Street 1:271 STATE ROUTE 288
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-3055
Practice Address - Country:US
Practice Address - Phone:724-773-4681
Practice Address - Fax:724-770-7966
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010542363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily