Provider Demographics
NPI:1245485580
Name:KUSTURISS, ELIZABETH (NP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:KUSTURISS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 CONESTOGA RD
Mailing Address - Street 2:BUILDING 1, SUITE 300
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1352
Mailing Address - Country:US
Mailing Address - Phone:610-565-6580
Mailing Address - Fax:610-525-3664
Practice Address - Street 1:200 BOWMAN DR STE E325
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9652
Practice Address - Country:US
Practice Address - Phone:856-247-7420
Practice Address - Fax:856-247-7421
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11544363L00000X
DE000000000363LW0102X
PASP012040363LX0001X
NJ26NJ00927900363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology