Healthcare Provider Details

I. General information

NPI: 1992401368
Provider Name (Legal Business Name): ERIC MATTHEW CUSTER ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 E HAWTHORNE RD
SPOKANE WA
99218-1417
US

IV. Provider business mailing address

5224 E LANE PARK CT
MEAD WA
99021-9026
US

V. Phone/Fax

Practice location:
  • Phone: 509-489-2369
  • Fax:
Mailing address:
  • Phone: 509-599-3952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61407853
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61407853
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: