NPI | 1952918880 |
---|---|
Former Name | AMESHA CUSTIS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: VA 0024180214) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024180214) |
Enumeration Date | 2020-09-24 |
Last Update Date | 2023-06-02 |