Healthcare Provider Details

I. General information

NPI: 1710914452
Provider Name (Legal Business Name): CYNTHIA LAWTHER CUSTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 W COLORADO AVE
COLORADO SPRINGS CO
80904-4023
US

IV. Provider business mailing address

910 SUMMER GAMES DR
COLORADO SPRINGS CO
80906-1381
US

V. Phone/Fax

Practice location:
  • Phone: 719-475-7162
  • Fax: 719-475-2201
Mailing address:
  • Phone: 719-389-1417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number91792
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: