Provider Demographics
NPI:1700604873
Name:MOHAN, ANOOB DANIEL (CRNP)
Entity type:Individual
Prefix:
First Name:ANOOB
Middle Name:DANIEL
Last Name:MOHAN
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 E LA CROSSE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-2002
Mailing Address - Country:US
Mailing Address - Phone:610-394-2130
Mailing Address - Fax:610-394-2177
Practice Address - Street 1:23 E LA CROSSE AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-2002
Practice Address - Country:US
Practice Address - Phone:610-394-2130
Practice Address - Fax:610-394-2177
Is Sole Proprietor?:No
Enumeration Date:2024-09-28
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP029374363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily