Provider Demographics
NPI:1023084837
Name:CASANOVA-GHOSH, ELENA C (CRNP)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:C
Last Name:CASANOVA-GHOSH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:C
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:SUITE 356 LANKENAU MOB EAST
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:484-476-8210
Mailing Address - Fax:610-552-0029
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:SUITE 356 LANKENAU MOB EAST
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:484-476-8210
Practice Address - Fax:610-552-0029
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP006089P364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232359401OtherMAIN LINE HEALTHCARE
PA232359401OtherMAIN LINE HEALTHCARE
Q06087Medicare UPIN