Provider Demographics
NPI:1811572308
Name:LUGANO, ELISABETH ROSE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:ROSE
Last Name:LUGANO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8121 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2136
Mailing Address - Country:US
Mailing Address - Phone:267-455-5289
Mailing Address - Fax:
Practice Address - Street 1:8121 CEDAR RD
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2136
Practice Address - Country:US
Practice Address - Phone:267-455-5289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP023409363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP023409OtherPENNSYLVANIA DEPARTMENT OF STATE