Provider Demographics
NPI:1124582598
Name:CUSTER, MICHELE (CRNP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:CUSTER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CETRONIA RD STE 303
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9168
Mailing Address - Country:US
Mailing Address - Phone:610-973-6200
Mailing Address - Fax:866-644-0894
Practice Address - Street 1:250 CETRONIA RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9147
Practice Address - Country:US
Practice Address - Phone:610-973-6200
Practice Address - Fax:866-644-0894
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2018085716363L00000X
PASP020096363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner