Provider Demographics
NPI:1770857138
Name:CUSTOM CARE NP SERVICES
Entity Type:Organization
Organization Name:CUSTOM CARE NP SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:740-272-7150
Mailing Address - Street 1:513 BIRCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1103
Mailing Address - Country:US
Mailing Address - Phone:740-272-7150
Mailing Address - Fax:740-362-2524
Practice Address - Street 1:513 BIRCHARD AVE
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1103
Practice Address - Country:US
Practice Address - Phone:740-272-7150
Practice Address - Fax:740-362-2524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.07465-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH092202Medicare UPIN