MEDICARE: JUDY A CUSTER CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	SP003221C	PA

General Provider Information

NPI Number	:	1942204540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY A CUSTER CRNP

Provider Business Mailing Address
First Line	:	342 RICHARD ST
Second Line	:
City	:	BEDFORD
State	:	PA
Zip	:	15522
Country	:	US
Telephone Number	:	814-623-8414
Fax Number	:

Provider Business Practice Location Address
First Line	:	342 RICHARD ST
Second Line	:
City	:	BEDFORD
State	:	PA
Zip	:	15522
Country	:	US
Telephone Number	:	814-623-8414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	06/02/2009

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