Provider Demographics
NPI:1720555717
Name:CUSTER, WENDI F (MA, RD, LDN)
Entity Type:Individual
Prefix:
First Name:WENDI
Middle Name:F
Last Name:CUSTER
Suffix:
Gender:F
Credentials:MA, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5734 TIPPERARY DR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-7581
Mailing Address - Country:US
Mailing Address - Phone:704-740-5681
Mailing Address - Fax:
Practice Address - Street 1:5734 TIPPERARY DR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-7581
Practice Address - Country:US
Practice Address - Phone:704-740-5681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001803133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered