| 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 |