NPI 1164666236

Betsy Custard

Practitioner Lodging Provider Prescott Valley, AZ

Practice location

Address: 3484 N Constance Dr., Prescott Valley, AZ 86314
Phone: (928) 443-1991
Mailing address: 440 N Washington Ave, Prescott, AZ 86301-2642

Registered specialties

Lodging Provider Primary

Other Service Providers Taxonomy 177F00000X Licence 12586 (AZ)

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Registry record

NPI: 1164666236
Entity type: Individual
Sex (as registered): Female
NPI issued: 21 Apr 2009
Record last updated: 21 Apr 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.