Healthcare Provider Details

I. General information

NPI: 1497661391
Provider Name (Legal Business Name): ALEXIS NICOLE CUSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 CAPITOL AVE
SACRAMENTO CA
95816-6039
US

IV. Provider business mailing address

2825 CAPITOL AVE
SACRAMENTO CA
95816-6039
US

V. Phone/Fax

Practice location:
  • Phone: 916-887-0000
  • Fax:
Mailing address:
  • Phone: 916-856-8728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95118001
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: